NCSL Tools for State Legislatures:
Medicare Prescription Drug Coverage |
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Updated: April 2, 2008
The Medicare Part D Prescription Drug Program started January 1, 2006. For 2008, the enrollment period ran from November 15 to December 31, 2007. Dual eligibles and persons newly eligible for Medicare (turning age 65, etc) may sign up throughout 2007 and 2008.
As of mid-2006 Medicare announced that more than 38.3 million Medicare beneficiaries are receiving prescription drug coverage. More than 93 million prescriptions were filled for these beneficiaries with drug coverage during March -- averaging 3 million prescriptions filled per day.
Although CMS did not extend the May 15th enrollment deadline in general for the Medicare population, they did make accommodation in June for low-income beneficiaries and those affected by Hurricane Katrina. For those eligible, the enrollment period has been extended through December 31, 2006 without penalty. The special enrollment period is only applicable to those applicants who apply and and receive the low-income subsidy and individuals who were affected by Hurricane Katrina. If an individual disenrolls from the Part D plan after 2006 and they do not have credible coverage for a period of 63 days or more, they would then incur a late enrollment penalty when they re-enroll in a plan.
NCSL worked with the Centers for Medicare and Medicaid Services (CMS) to provide timely, user-friendly materials to state legislators so they may inform their constituents, colleagues, friends, family members and loved ones about the opportunities and requirements for the new benefit. (1)
This web page provides helpful and updated materials. Most of the material is designed so you can print or download copies for your own use in your district. We will provide more information to you as it becomes available.
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Rx Sessions at NCSL Fall Forum in San Antonio, Texas - December 7, 2006.
Update on State Actions Related to Medicare Part D Prescription Drug Coverage
On January 1, 2007, the second year of Medicare pharmaceutical benefits began. Many states continue to play a significant role for seniors and persons with disabilities needing medicines - by providing "wrap around" subsidies for premiums and coverage gaps, by problem-solving and by sponsoring programs for those not eligible for Medicare. New commercial plan designs, questions about state "clawback" payments, Medicaid program responses and possible actions in Congress all loom as legislators prepare to tackle state pharmaceutical budgets and policy. Four experts share news and trends.
- Steven McAdoo, Deputy Regional Administrator, Centers for Medicare and Medicaid Services (CMS Region 6), Dallas, Texas | PowerPoint [3.8 Mb]
- Richard Cauchi, Health Program Director, NCSL Staff, Colorado | PowerPoint
- Joy Johnson Wilson, Health Policy Director, NCSL staff, Washington, DC
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Annual Meeting Rx Sessions - held August 16, 2006 in Nashville, TN.
- "Medicare Prescription Drug Coverage and the States" - Even with the Medicare Part D Program well underway, states continue to play important roles in prescription drug coverage for millions of low-income people. In addition to supplementing the new federal coverage, many states are modifying their State Pharmaceutical Assistance Programs and making adjustments to Medicaid and other Rx programs.
* Vernon Smith, Principal, Health Management Associates, Lansing, Michigan PowerPoint Online  | html
* Assemblymember Richard Gottfried, Chair, Assembly Health Committee, New York State * Gloria Parker, Associate Regional Administrator, Centers for Medicare and Medicaid Services, Region Four, Atlanta, Georgia PowerPoint Online * Edward Belkin, VP for Communications and Public Affairs, Pharmaceutical Research and Manufacturers of America, D.C. PowerPoint Online * Moderator: Senator Judy Lee, North Dakota - "Prescription Drug Discounts: from 340B to Consumer Cards." - For the 40+ million Americans not on Medicare or comprehensive private insurance, access to prescription drugs remains a visible concern. The federal 340B drug discount program provides one significant option - including a fast-expanding network of clinics and pharmacies in every state. In addition, user-friendly industry-sponsored assistance cards and new state discount laws keep pharmaceuticals near the top of policymakers' priority lists.
* Harry Hagel, Senior Director, HRSA Pharmacy Services Support Center, Washington, DC PowerPoint Online
* Roba Whiteley, Executive Director, Together Rx Access, Alexandria, Virginia PowerPoint Online | html
* Moderator: Senator Renee Unterman, Georgia
- NCSL MEDICARE RESOURCE CENTER updated 7/06.
- State Pharmaceutical Assistance Programs in 2006-07: Helping to Make Medicare Part D Easier and More Affordable An analysis of laws and regulations providing state-funded prescription drug wrap around benefits, coordination and ease of enrollment for 1.5+ million residents in more than 20 states. Updated regularly. [30 pages]
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State Transitional and Emergency Coverage for Medicare Part D - An archive of special funding and powers used January-July 2006.
- 2005 Medicare and State Pharmaceutical Coordination Legislation - NCSL's report - featuring 130+ bills in over 40 states.
- Medicare Part D: Latest State Updates. NCSL SPRING FORUM- RX Session: held Friday, April 7, 2006 in Washington DC. As part of their ongoing efforts to help Medicare. Speakers:
* Joseph Fine and Cora Tracy, [PowerPoint download / slides] - Centers for Medicare and Medicaid Services, Baltimore, MD.
* Richard Cauchi and Donna Folkemer, [PowerPoint download / slides] -NCSL staff Directors, Denver and Washington, DC.
- "Legislators and Medicare Prescription Benefit" -Web-assisted audio conference: 11/7/05
* Speakers: Leslie Norwalk, Deputy Administrator, CMS [PowerPoint]
* Rep. Betty Boyd (CO), Vice-Chair of NCSL Health Committee [PowerPoint]
* Donna Folkemer, Director, NCSL Forum for State Health Policy Leadership. |
OTHER RESOURCES, 2007-08:
- Medicare Prescription Drug Plans in 2008 and Key Changes Since 2006: Summary of Findings - Kaiser FF fact sheet, 4/2/08. [7 pages PDF ]
- State-level Medicare Part D Plan Characteristics, A 2007 Update - Kaiser FF fact sheet, 3/07
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"The Impact Of Medicare Part D On Prescription Drug Use By The Elderly," - A new study examining the effect of the new Medicare prescription drug benefit on the elderly shows that it led to the consumption of an additional 158 million prescriptions in 2006 at a cost of $32 billion to Medicare. Many seniors already had prescription drug coverage, so the new benefit reduced the average amount paid by seniors per day of therapy by 18.4 percent, and increased the elderly's prescription drug use by only 13 percent. As for the crowd-out rate, the researchers found that every seven prescriptions paid for by the government crowded out five prescriptions and resulted in only two additional prescriptions used. The federal government spent about $203 for each additional prescription for the elderly, or about 3.5 times as much as the average price ($57) for a prescription in 2006. published by Health Affairs, Nov/Dec 2007.
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"Medicare Part D: The First Year" - IMS Health presents an evidence-based perspective on the first year of the Medicare Part D program and its impact on pharmaceutical usage. The report examines the impact of Medicare Part D on key issues such as access to therapy, out-of-pocket spending, rates of compliance and persistency, generic drug usage and the coverage gap caused by beneficiaries reaching their initial coverage limit. Published 7/07. [12 pages, PDF].
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- The Medicare Drug Benefit: Changes in California for 2008 11/9/07
(1) The web page was initiated as a partnership between NCSL and CMS in 2005. The 2008 edition is produced and edited by NCSL, which is entirely responsible for editorial content. |
Featured Links
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The U.S. House Committee on Oversight and Government Reform Report: "Private Medicare Drug Plans"
Administrative costs of Medicare Part D are six times higher than the cost of traditional Medicare.
Drug manufacturer rebates received by Part D insurers are significantly smaller than rebates received by Medicaid. |
