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Slide 1: Medicare Part D: Accomplishments and Shortcomings Click to edit Master subtitle style Kara Smail NURS 501 3/20/10
Slide 2: Objectives • Have a better understanding of Medicare Part D Prescription Drug Plan. Accomplishments and Benefits. Disadvantages and Struggles. How Medicare Part D affects Advanced Practice Nurses. • • • 3/20/10
Slide 3: Medicare Prescription Drug Coverage • Federal Program Enacted in part of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 Went into effect January 1, 2006 • • 3/20/10
Slide 4: • Two types of Private Plans Voluntary Enrollment in Medicare Part D • • Early enrollment was encouraged especially for healthy beneficiaries. Dual Eligibility (also part of Medicaid) 1,824 stand-alone plans and vary by region Prescription Drug Plan Finder Premiums vary depending on the plan chosen by the beneficiary. • • • • 3/20/10
Slide 5: Plan Formularies • Not all Plan D plans are required to pay for all covered Plan D drugs. Each plan has it’s own formulary. Organized into tiers The lower the tier, the lower the co-payment • • • 3/20/10
Slide 6: Excluded drugs for all plans • Drugs used for: Anorexia, Weight Loss and Weight Gain Fertility Erectile Dysfunction Cosmetic Purposes Symptomatic Relief of Coughs and Colds Barbiturates Benzodiazepines • • • • • • • 3/20/10
Slide 7: Medicare Coverage Gap or “Doughnut Hole” • Gap between the initial coverage and catastrophic coverage. Drugs up to $2250 in cost. Medicare will cover 25%. Any cost above $2250, Medicare will not cover any cost. $4350 and above Medicare will cover 95% of the cost. • • • 3/20/10
Slide 8: Closing the Gap • Would require an increase in federal spending: $134 billion over 10 years. Proposal has been made to gradually close the gap over a 15-year period. Low-income subsidies to assist in gap coverage. • • 3/20/10
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Slide 10: • Before Medicare Part D, beneficiaries were not filling vital prescriptions. Improvement on Quality of Care and Health Outcomes • By June 2009, 22.5 million seniors had enrolled in Medicare Part D, 15.8 million had another source of drug coverage and 4.4 million (10%) still had no coverage. After Medicare Part D, beneficiaries were filling prescriptions and had better control over chronic conditions. • 3/20/10
Slide 11: More Accomplishments • 5.9-12.8% increase in prescription drug use and use of selected essential medications. 13.1-15.6% decrease in out-of-pocket expenses. Low-income subsidy programs • • 3/20/10
Slide 12: Disadvantages • “Doughnut Hole” or Coverage Gap Dual Eligibility Affect on Nursing Home Residents Prior authorization Appeals and Resubmissions Step Therapy • • • • • 3/20/10
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Slide 14: Impact on Advanced Practice Nurses • Medicare Part D Plans and Health Care Providers’ goals do not match. Patients returning with complications related to not filling prescriptions due to drug costs. Educate on subsidy programs for assistance in gap coverage and other ways to assist in lowering drug costs. • • 3/20/10
Slide 15: Conclusion 3/20/10
Slide 16: References Andrews, W. (2006, July 27). Medicare coverage gap. Retrieved from http://www.cbsnews.com/video/watch/?id=1839309n&tag=mncol;lst;6 McDermott, T. (2006, May 9). Notebook: medicare in nursing homes. Retrieved from http://www.cbsnews.com/stories/2006/05/09/notebook/main1604406.shtml?tag=contentM ain;contentBody Medicare: The Official U.S. Government Site for People with Medicare. (2009, October 30). Retrieved March 8, 2010, from http://www.medicare.gov/bridging-the-gap.asp Neuman, P., & Cubanski, J.. (2009). Medicare Part D Update -- Lessons Learned and Unfinished Business. The New England Journal of Medicine, 361(4), 406-14. Retrieved March 1, 2010, from Research Library Core. Schneeweiss, S., Patrick, A., Pedan, A., Varasteh, Levin, R., Liu, N., & Shrank, W.. (2009). The Effect Of Medicare Part D Coverage On Drug Use And Cost Sharing Among Seniors Without Prior Drug Benefits. Health Affairs, (28), 305-316. Retrieved March 1, 2010, from ABI/INFORM Global. 3/20/10
Slide 17: Stevenson, D., Huskamp, H., & Newhouse, J.. (2008). Medicare Part D and the Nursing Home Setting. The Gerontologist, 48(4), 432-41. Retrieved March 1, 2010, from Research Library Core. 3/20/10