Wrapping Around Medicare Part D: States Plans in 2006

1
Wrapping Around Medicare Part D States Plans in
2006

• Presented by Kimberley Fox,
• Senior Policy Analyst,
• Institute for Health Policy

2
Overview of Presentation

• Describe options for Medicaid and State Pharmacy
  Assistance Programs to supplement Part D.
• Present results of a survey of Medicaid and SPAP
  Part D plans conducted in Fall 2005.
• Discuss potential options to advocate for in
  states that could be doing more.

3
Survey Methods

• Funded by the National Pharmaceutical Council
• Literature and document review
• Fall 2005 survey w/ telephone follow-up
• Snapshot of states plans for adapting programs
  to MMA
• 28 existing SPAP programs in 24 states 4 new
  SPAPs
• 14 Medicaid agencies (representing 66 of
  Medicaid drug spend), 11 in states with SPAPs.
• Response rate _at_96
• Many states still working out details findings
  reflect answers provided at time of survey
  completion.

4
State Pharmacy Programs and Part D

• Medicaid
• Responsibilities for transitioning duals
• May fill Part D gaps with state-only dollars
• Clawback payments
• LIS application and MSP screening
  responsibilities.
• State Pharmacy Assistance Programs (SPAP)
• Special privileges offered to SPAPs
• State payments count toward TROOP -- people
  through donut hole to catastrophic coverage
  sooner.
• Transitional grant funds to help educate
  enrollees re Part D.
• Plans must work with SPAPs to coordinate payment
• Restrictions on SPAPs to be eligible for special
  privileges
• Must provide financial assistance for purchase or
  provision of supplemental drug coverage
• Cannot receive federal funding
• Must provide assistance without discriminating
  based on which Part D plan a person chooses

5
SPAP and Medicaid Part D Gap-filling Options

• Medicaid
• Premium assistance above LIS
• Copayments
• Off-formulary/PDP denied drugs or during appeals
• Non-Part D covered drugs (eligible for FFP)
• SPAP
• Premium assistance (LIS or full premium)
• Wrap around full/partial LIS or non-LIS
  out-of-pocket costs
• Deductibles, copayments, donut hole,
• Off-formulary/PDP denied drugs or out-of-network
  pharmacies
• Non-Part D covered drugs

6
Filling Part D Gaps for Duals Selected Medicaid
Plans 2006
NY
NY
NJ
NJ
NY,NJ
NY,NJ
NJ
NJ
Source Part D Survey of SPAP and Medicaid
Directors, Fall 2005.
7
SPAP Plans Once Part D Begins, 2006
8
Specific Part D Gaps Filled by SPAPs, 2006
Source Part D Survey of SPAP and Medicaid
Directors, Fall 2005.
9
Part D Transitional Enrollment Issues for SPAP
Enrollees and Duals

• Duals
• Medicaid drug coverage ends Jan 2006
• All duals deemed eligible for low income
  subsidies
• All duals randomly assigned to PDPs by CMS Nov
  2005
• State Medicaid agencies may conduct formulary
  matches to recommend more appropriate plans.
• SPAP Enrollees
• Not deemed eligible for LIS, most enrollees must
  apply (exc. MSPs)
• All enrollees must voluntarily enroll in
  PDP/MA-PD
• Qualified SPAPs cannot auto-enroll enrollees into
  a preferred plan
• State options to facilitate LIS application/Part
  D enrollment
• Mandating Part D and LIS
• Authorized representative status
• Collecting asset information/submitting LIS on
  behalf of enrollees
• Co-branding
• Intelligent Random Assignment

10
Medicaid Transition Plans for Part D Enrollment,
2005
Source Part D Survey of SPAP and Medicaid
Directors, Fall 2005.
11
More than Half of SPAP Enrollees Will Not Qualify
for Full LIS N26 programs/23 states
Percentages based on estimates by state
officials from income data, generally do not
include assets.
Source Part D Survey of SPAP and Medicaid
Directors, Fall 2005.
12
SPAP Efforts to Enroll Members in LIS, 2005
N17
For LIS and/or Part D Enrollment
Source Part D Survey of SPAP and Medicaid
Directors, Fall 2005.
13
SPAP Efforts to Enroll Members in Part D Plans,
2005
N17
For LIS and/or Part D Enrollment
Source Part D Survey of SPAP and Medicaid
Directors, Fall 2005.
14
Few States Expanding SPAPs to New Groups
Source Part D Survey of SPAP and Medicaid
Directors, Fall 2005.
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Summary of State Actions

• Medicaid largely not filling Part D gaps for
  duals, except Part D excluded drugs.
• NJ and NY doing more
• SPAPs holding existing enrollees harmless, but
  not expanding benefits/eligibility
• Only a few states starting new SPAPs
• States generally exercising caution wait and see
  approach.

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Future Policy Options

• Medicaid
• State emergency funding presents opportunity to
  see what is NOT covered by Part D for duals.
• Best practice states - NJ and NY
• Other more modest interventions
• Urge more states to assign duals based on drug
  history.
• Holding duals harmless to existing Medicaid
  copayments.
• SPAPs
• Do more to maximize fedl s
• Collecting asset info and submitting LIS apps on
  their behalf
• Assigning to plans based on drug history conduct
  cost/benefit of paying non-LIS premiums
• Direct SPAP savings to fill gaps for those with
  greatest need in each state
• Asset ineligible LIS Up to 200 FPL disabled
  (NV)
• Expand benefits to other rx uninsured non-elderly
  (e.g. WY/MD)
• New SPAPs good return on investment
• Tracking impact of Part D - SPAPs unique position
  to monitor effect of Part D because they have
  access to data.

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Further Information

• For copies of this presentation
• kfox_at_usm.maine.edu
• Full report of survey findings available in
  February under Publications at
• http//muskie.usm.maine.edu/research/research_inst
  itutes_ihp.jsp