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News and Information Article
WASHINGTON, March 21 // -- A new analysis shows that many of
Californias one million dual-eligible beneficiaries receive inferior drug
access to key drugs under Medicare Part D compared to their previous state-
sponsored Medicaid coverage. The study, prepared by Avalere Health, was
released by the California HealthCare Foundation and will be presented today
to the California State Assembly.
Using its proprietary DataFrame(TM) tool, Avalere Health analyzed CMS
publicly available data from October 2005 to assess if drug coverage for
Californias dual-eligible beneficiaries is better or worse after the
transition to Part D drug plans. Their evaluation of the ten prescription
drug plans (PDPs) that accepted Californias auto-assigned dual-eligible
beneficiaries revealed many instances of inferior coverage when compared to
previous coverage offered by Medi-Cal, the state Medicaid program:
* PDPs accepting dual-eligibles cover a low of 626 drugs and a high of
3,360.
* While Medi-Cal covered 20 anti-psychotic drugs -- known for their
tendency to work differently on each individual patient -- some auto-
enrollment PDPs cover a low of 15 of the same drugs. Avaleres review
of two subclasses of cardiovascular drugs showed that while Medi-Cal
covered 26 drugs, auto-enrollment PDPs cover between 12-32 of these
drugs.
* Avaleres review of Part D auto-enrollment PDPs shows instances where
up to 38% of anti-psychotic drugs required prior authorization by one
PDP, marking a distinct departure from Medi-Cals prior authorization
practices for these drugs and opening the door for beneficiaries to
experience disruptions in access to these medications.
The report also found evidence that certain federal intentions to extend
protections had been met by the marketplace. A closer look at four classes of
drugs -- including two designated as "protected" by the federal government and
two that are unprotected -- showed that federal efforts to ensure broader
coverage of protected classes of drugs generally improved access in
California. For example, on average, 93% of anti-psychotics and anti-
retroviral drugs are covered on drug plans offered in California, versus an
average of 63% of anti-hypertensive and anti-cholesterol drugs.
"The wide variance in plans accepting dual-eligibles calls into question
the appropriateness of the auto-assignment policy for enrolling this group of
beneficiaries," said Jon Blum, vice president of Avalere Health and a
contributing author to the paper.
In addition to its look at Californian dual-eligibles coverage under the
new drug benefit, Avaleres analysis of the California Part D marketplace
revealed a number of data points that highlight the complex choices
beneficiaries are experiencing nationally:
* There are a total of 164 drug plans in California. LA County residents
have 71 plans to choose from.
* Among these 164 plans, cost-sharing tiers range from two to eight
tiers. Standard commercial drug plans average three tiers.
* Among these 164 plans, the number of drugs on formulary ranges from 530
to 3,360 (out of an approximate 8,000 FDA approved drugs).
* Monthly premiums range from $0.00 - $66.08, with deductibles ranging
from $0 - $250.
"As Medicare beneficiaries learn to navigate these choices, policymakers
and advocates should remain vigilant in their monitoring of issues and support
of beneficiary education," said Chiquita White, a Medicaid expert at Avalere
Health and a contributing author of the study.
One in four Californian Medicare beneficiaries is a dual-eligible, and one
million of the 6.2 million national dual-eligibles live in California. Dual-
eligibles are the only Medicare beneficiaries that were auto-enrolled into the
Part D program.
The issue brief, entitled "The Medicare Drug Benefit: How Good Are the
Options?" is available to download at
http://www.chcf.org/topics/view.cfm?itemID=119451. The authors are Chiquita
White, Eli Sprecher, Elizabeth Hinshaw, and Jon Blum, all of Avalere Health.
Editors Note: Avalere Health experts will present these findings at a
Joint Informational Hearing of the California State Assembly Health Committee
and Assembly Long-Term Care Committee in Sacramento, California. Avaleres
Jon Blum will present along with Stan Rosenstein of California Department of
Health Services; Michael Negrete of the California Pharmacists Association;
Greg Knoll, Legal Aid Society of San Diego; and Jeanne Finberg, National
Senior Citizen Law Center among other experts. Blums presentation will be
available to download Wednesday from http://www.avalerehealth.net.
Avalere Health is a leading advisory company focused on healthcare
business strategy and public policy. It serves a diverse client base, which
includes Fortune 500 healthcare technology companies, Federal government
agencies, and major medical foundations. The company is organized into six
practice areas -- Medicare, Medicaid, Reimbursement, Long-Term Care, Health
Information Technology, and Education. Anchored by a comprehensive research
engine and staffed by experts in business, medical product commercialization,
and health policy, Avalere provides strategic guidance, objective analytic
research, and quality educational programs focused on a wide range of
healthcare issues facing our nation.
Further information can be obtained at http://www.avalerehealth.net.
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