AcuPartD

Keeping you updated on the latest Medicare and Part D news


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US life expectancy declines for first time in 20 years

Data released by the National Center for Health Statistics (CDC) reports life expectancy in the US has declined for the first time in more than 20 years. Life expectancy dropped from 76.5 years in 2014 to 76.3 in 2015 for men and from 81.3 to 81.2 for women. Overall life expectancy dropped by 0.1 years in 2015, to 78.8 years.

This decline in life expectancy equates to men dying, on average, two months earlier and women dying a little over one month earlier. The last decline in life expectancy occurred in 1993, during the high of the HIV/AIDS epidemic.

The preliminary figures depict rises for eight of the ten leading causes of death, including big rises in death caused by heart disease, Alzheimer’s disease, and accidental deaths among infants.

Experts have pointed to rising obesity levels, an ageing population, and rising “social stressors,” which includes economic struggles and addiction (ex. the current opioid epidemic) as wider factors in stagnating and declining life expectancy.

The US currently ranks 28th out of 43 OECD countries in life expectancy and has the 12th highest infant mortality of the same countries.

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CMS Medicare Drug Spending Dashboard Updated with CY2015 Data

This week, CMS updated their interactive Medicare Drug Spending Dashboard with data from 2015.  The online tool provides users with Part B and Part D spending information for drugs with high spending on a per user basis, drugs with high overall spending, and drugs with large per unit cost increases.  The tool returns relevant spending, utilization, and trend data as well as drug information, manufacturer, and uses in a user-friendly format.

Detailed methodology and the underlying data set are also available for download.

Part D Total Spending, Top 5 Drugs CY2015

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Part D Dashboard Summary for CY2014 and CY2015

# of Drug Products* Total Program Spending Percent of Program Spending
2014 2015 2014 2015 2014 2015
All Drugs 3,761 3,812 $121.5B $137.4B 100% 100%
All Drugs with Total Program Spending >$250M 115 119 $76.7B $88.0B 63% 64%
Top 15 Total Program 15 15 $29.1B $35.6B 24% 26%
Spending Drugs
All Drugs with Annual Per-User Spending >$10K 267 335 $26.2B $37.9B 22% 28%
Top 15 Drugs with Annual Per-User Spending >$10K 15 15 $9.3B $9.2B 8% 7%
All Drugs with Unit Cost Increases >25% 540 538 $13.7B $8.7B 11% 6%
Top 10 Drugs with Unit Cost Increases >25% 10 10 $1.3B $1.4B 1% 1%
All Drugs Included in Dashboard 40 40 $39.7B $46.2B 33% 34%
* Drug Products defined by distinct Brand Name and Generic Name (First Databank), excluding over the counter drugs.


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Many Questions About Trump’s Health Care Policy Remain

For seniors in the midst of Medicare open enrollment, which lasts this year from October 15 to December 7, questions remain about how a Trump presidency will affect Medicare.  The president-elect made clear his intention to repeal the Affordable Care Act throughout his campaign and has since established a page on his website dedicated to his plans to reshape the nation’s healthcare system.  He includes steps to “modernize Medicare” and increase state flexibility with regard to Medicaid.  Trump promised throughout his campaign to leave Medicare untouched, though his campaign seems to be leaving the door open to some reforms.

Pharmaceutical stocks have gained in the days since Trump’s surprise victory over Hillary Clinton last Tuesday.  President-elect Trump continues to call for a replacement to the Affordable Care Act though he has yet to offer a specific plan nor clarified how he plans to combat the rising medication and health care costs for most Americans.  Regardless, any changes have the potential to greatly impact the drug marketplace and the drug price issue is unlikely to go away in the coming years.  During the Republican primary presidential campaign, Trump indicated that he was open to having the federal government negotiate directly with pharmaceutical companies to secure lower prices, as other nations such as Canada do.  It is unclear if this remains part of Trump’s plan or was merely an idea proposed on the campaign trail.


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2016 Medicare Part D Low-Income Subsidy and Plan Performance

Wrapping up our coverage of the recently released Medicare Part D in 2016 and Trends over Time report from the Health Policy Institute at Georgetown University and the Kaiser Family Foundation are findings related to the Low-Income Subsidy (LIS) program and plan performance ratings.

The report found that nearly 3 in 10 Part D beneficiaries receive financial subsidies through the Low-Income Subsidy program.  This number has grown steadily over the past decade, reaching 12 million in 2016.  About two thirds of LIS enrollees  (roughly 8 million) are enrolled in stand-alone PDPs; others are in standard MA-PD plans, Special Needs Plans (SNPs), Medicare-Medicaid plans participating in financial alignment demonstrations, cost plans, or PACE plans.  PDP LIS enrollment has been relatively constant since the program began, but MA-PD plan enrollment has expanded greatly since 2006.

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In 2016, MA-PD plans are far more likely than PDP plans to have 4 or more stars out of a possible 5 stars for the rating factors based on their Part D performance.  The average PDP plan star rating average has fluctuated in recent years while the MA-PD plan average has been increasing steadily.  Both plan types are rated on the same Part D performance factors.

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Medicare Part D spending on the EpiPen has increased by 1151% since 2007

A recent report by Kaiser Family Foundation (KFF) examined trends in Medicare spending on EpiPens from 2007 to 2014. KFF found that since Mylan acquired EpiPen from Merck in 2007, prices for a two-pack of EpiPens have increased by almost 550%, from $94 in January 2007 to $609 in May 2016.

The KFF analysis demonstrated that the EpiPen price increases have translated into higher spending fro Medicare Part D plans, enrollees, and program overall, leading to higher cost sharing and higher premiums for consumers. The average out-of-pocket spending by enrollees for each prescription doubled among non-LIS enrollees, from $30 to $56.

The analysis found that Part D spending increased from $7 million in 2007 to $87.9 million in 2014, an 1151% increase. At the same time, the number of enrollees using EpiPens also increased, but at a much, much slower rate, only increasing by 164%, from 80,000 to 211,000 enrollees. KFF 1.PNGOn a per prescription basis, the average total spending increased by 383%, rising from an average of $71 in 2007 to $344 in 2014, a nearly five-fold increase. Compared to the annual growth rate of Medicare overall (per capita), the annual growth rate for total Part D EpiPen spending (per prescription) was significantly higher. For example, in 2014, the annual growth rates were 34% and 8.6% for EpiPen spending and overall Medicare spending, respectively. KFF 3.PNG

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2016 Medicare Part D Benefit Design and Cost Sharing

Last week’s Medicare Part D in 2016 and Trends over Time report from the Health Policy Institute at Georgetown University and the Kaiser Family Foundation found that most PDP and MA-PD enrollees in 2016 were in plans with tiered pharmacy networks, no additional gap coverage, enhanced benefits, 5 tier formularies, and low deductibles.  PDPs and MA-PDs differ in some significant categories though – a much larger percentage of MA-PD enrollees are in enhanced plans and more PDP enrollees are in plans with tiered pharmacy networks.

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The report also found that close to 60% of beneficiaries enrolled in PDP plans have plans that offer only the basic benefit. This is down from 83% a decade earlier.  Additionally, about half of all enrollees in 2016, in PDPs and MA-PDs, are in plans that do not charge the Part D deductible.  Tiered pharmacy networks have grown in recent years and are now the new norm in PDP plans.

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8915-exhibit-3-13.pngNext week we will conclude this exploration of the Medicare Part D in 2016 and Trends over Time report by digging deeper into the Low Income Subsidy and Plan Performance Ratings.


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2016 Medicare Part D Premiums

Last week’s Medicare Part D in 2016 and Trends over Time report from the Health Policy Institute at Georgetown University and the Kaiser Family Foundation provides a snapshot of Part D in 2016 and trends over the past decade.  A previous post covered Part D enrollment trends from over the past decade.  Part D premiums for most beneficiaries enrolled in PDP plans increased in 2016.  This increase marked the end of 6 years of little change.  As the chart below indicates, MA-PD plans in 2016 continued the recent trend of modest growth.  Close to 50% of beneficiaries in 2016 enrolled in MA-PD plans paid no monthly premium for Part D coverage.8915-exhibit-2-1.png

As might be expected, geography plays a considerable role in Part D premiums.  PDPs offering comparable benefits can vary by as much 6 times the cost, depending on the region.  Even within the same geographic area, there can be large differences in stand-alone PDP premiums.

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In the coming days, we will take a closer look at 2016 Medicare Part D benefits, the LIS program, and plan performance ratings.