Recent research from Avalere Health, LLC using Medicare Part D reveals some interesting trends. Overall, premiums for fee-for-service prescription drug plans (PDPs) increased by 3%. For beneficiaries who enrolled in a Top 10 plan, however, premiums actually decreased by 6%. This result was driven by a 12% decrease in premiums for the largest PDP, AARP MedicareRxPreferred and the recent arrival of the low cost Humana-Walmart-Preferred Rx Plan.
Although the total number of Special Needs Plans (SNP) has held fairly steady over time, the number of enrollees in a dual-eligible SNP has risen by 11% between 2010 and 2011. Additional information on SNPs is below.
Within the Medicare Advantage program, enrollment in HMO and PPO plans continues to grow as PFFS enrollment declines.
Additional Part D trends are highlighted below. This spreadsheet provides even more detail.
Plan Consolidation in 2011
- The top 3 PDP plans made up 45.4% of all PDP enrollees. The top 10 plans made up 73.2% of all PDP enrollees.
- CIGNA Medicare Rx Plan One joined the top 10 PDPs as did the Humana Walmart-Preferred Rx Plan.
- UnitedHealth, Humana, and Kaiser provide MA benefits to 44% of all MA enrollees
Part D Sponsor Acquisition and Plan Consolidation
- CVS Caremark will acquire Universal American’s PDP plans and members after Q1 of 2011
- AARP MedicareRxSaver consolidated into AARP MedicareRxPreferred
- PrescriberRxBronze consolidated into Community CCRxBasic
Prices
- Overall, PDP premiums increased by 3%. For beneficiaries who enrolled in a Top 10 plan, however, premiums actually decreased by 6%. This result was driven by a 12% decrease in premiums for the largest PDP, AARP MedicareRxPreferred and the advent of the low cost Humana-Walmart-Preferred Rx Plan.
Special Needs Plans
According to the CMS website, Special Needs Plans (SNPs) were created by Congress in the Medicare Modernization Act (MMA) of 2003 as a new type of Medicare managed care plan focused on certain vulnerable groups of Medicare beneficiaries: the institutionalized, dual-eligibles and beneficiaries with severe or disabling chronic conditions. These beneficiaries are typically older, with multiple comorbid conditions, and thus are more challenging and costly to treat. Dual-eligible SNPs also offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid…Specific legislative and regulatory provisions allow SNPs to focus on specific subsets of the Medicare population with the intent to improve care and control costs for these beneficiaries. Consistent, comparable measures that reflect the service delivery and outcomes important to these populations and that promote quality improvement and maturation of SNP products are necessary.
The fifteen SNP-specific chronic conditions approved for 2010 are: 1) Chronic alcohol and other drug dependence; 2) certain auto-immune disorders; 3) cancer (excluding pre-cancer conditions; 4) certain cardiovascular disorders; 5) chronic heart failure; 6) dementia; 7) diabetes mellitus; 8 ) end-stage liver disease; 9) end-stage renal disease requiring dialysis; 10) certain hematologic disorders; 11) HIV/AIDS; 12) certain chronic lung disorders; 13) certain mental health disorders; 14) certain neurologic disorders; and 15) stroke.
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