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1
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33746874918
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-
note
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Although plans might offer more-generous coverage, the "standard" benefit includes a premium that covers 25 percent of the drug benefit, a $250 deductible, 25 percent coinsurance up to $2,250 in total drug costs, 100 percent coinsurance (that is, no coverage) from $2,250 to $5,100 in total drug costs (the gap or "doughnut hole"), and 5 percent coinsurance above $5,100 in total drug costs.
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-
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2
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33746911662
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-
note
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Medicare risk HMOs were authorized by the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982. The precursor to the Medicare Advantage program, Medicare+Choice (M+C), was established by the Balanced Budget Act (BBA) of 1997.
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-
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3
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33746876408
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Confusion Is Rife about Drug Plan as Sign-Up Nears
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12 November
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R. Pear, "Confusion Is Rife about Drug Plan as Sign-Up Nears," New York Times, 12 November 2005;
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(2005)
New York Times
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Pear, R.1
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5
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33746931787
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note
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Some beneficiaries obtain coverage for outpatient prescription drugs outside of Medicare through a Medigap policy, a plan sponsored by a current or former employer, or a state Medicaid or pharmacy assistance program.
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-
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6
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0036760685
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Payment Policy and Competition in the Medicare+Choice Program
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In 2001 under M+C, a beneficiary in an urban county was more than twenty times more likely than one in a rural county to have access to a local private plan. See S.D. Pizer and A.B. Frakt, "Payment Policy and Competition in the Medicare+Choice Program," Health Care Financing Review 24, no. 1 (2002): 83-94. Preferred entry by local plans into urban counties has continued under the MA program.
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(2002)
Health Care Financing Review
, vol.24
, Issue.1
, pp. 83-94
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-
Pizer, S.D.1
Frakt, A.B.2
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7
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17144369227
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Medicare Advantage: Déjà Vu All over Again?
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published online 15 December 2004; 10.1377/hlthaff.w4.586
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See B. Biles, G. Dallek, and L.H. Nicholas, "Medicare Advantage: Déjà Vu All Over Again?" Health Affairs 23 (2004): w586-w597 (published online 15 December 2004; 10.1377/hlthaff.w4.586).
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(2004)
Health Affairs
, vol.23
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-
Biles, B.1
Dallek, G.2
Nicholas, L.H.3
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8
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33646913560
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(Prepared for the Centers for Medicare and Medicaid Services by RTI International, CMS Contract no. 500-00-0024), March
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L. Greenwald et al., "Medicare Preferred Provider Organization (PPO) Case Study and Implementation Report" (Prepared for the Centers for Medicare and Medicaid Services by RTI International, CMS Contract no. 500-00-0024), March 2004, http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/ PPO_Implementation_Report.pdf (accessed 10May 2006).
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(2004)
Medicare Preferred Provider Organization (PPO) Case Study and Implementation Report
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Greenwald, L.1
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9
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33847716653
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Defective Design: Regional Competition in Medicare
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published online 23 August 2005; 10.1377/hlthaff.w5.399
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S.D. Pizer, R. Feldman, and A.B. Frakt, "Defective Design: Regional Competition in Medicare," Health Affairs 24 (2005): w399-w411 (published online 23 August 2005; 10.1377/hlthaff.w5.399).
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(2005)
Health Affairs
, vol.24
-
-
Pizer, S.D.1
Feldman, R.2
Frakt, A.B.3
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10
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34250180778
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2 March
-
A list of the states in each MA and PDP region is available at CMS, "Overview," 2 March 2006, http://www.cms.hhs.gov/ PrescriptionDrugCovGenIn/ (accessed 9 March 2006).
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(2006)
Overview
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-
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11
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34250180778
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"Overview," 2006, http://www.cms.hhs.gov/ PrescriptionDrugCovGenIn/ Ibid.
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(2006)
Overview
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-
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12
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33746929953
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-
note
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The top 100 drugs are the 100 most commonly purchased by Medicare beneficiaries using Medicare-approved drug discount cards. CMS staff, personal communication, 12 April 2006.
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-
-
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13
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16244384766
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-
Pub. no. 04-103 (Washington: Families USA)
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The list of thirty brand-name drugs most prescribed to seniors participating in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly was compiled in Families USA, Sticker Shock: Rising Prescription Drug Prices for Seniors, Pub. no. 04-103 (Washington: Families USA, 2004).
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(2004)
Sticker Shock: Rising Prescription Drug Prices for Seniors
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-
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14
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33746870469
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21 February
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Because the program's formulary likely influenced the number of prescriptions written for a drug, we eliminated from consideration any drugs not in the top fifty brand-name drugs sorted by retail sales volume as compiled in Drug Topics, "Top 200 Brand-Name Drugs by Retail Dollars in 2004," 21 February 2005, http://www.drugtopics.com/drugtopics/data/articlestandard/ drugtopics/112005/150644/article.pdf (accessed 28 April 2006). We eliminated from consideration Vioxx (because it has been recalled) and Celebrex (because its popularity likely declined as a result of concerns of increased risk of heart attack or stroke).
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(2005)
Top 200 Brand-Name Drugs by Retail Dollars in 2004
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-
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15
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33746891962
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-
note
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The twelve drugs selected are listed in Exhibit 4.
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-
-
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16
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33746893103
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-
note
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Service area and copayment amounts were obtained from plans' Web sites and marketing material or from plan representatives. The fifteen selected plans are listed in Exhibit 3.
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-
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17
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33746898303
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-
note
-
Other organizations, including the CMS, have circulated lists of "national plans" that differ from ours. Our list includes plans offered by large insurers that might not be available everywhere (for example, Humana's PDPs are not offered in four states). Lists made available by other organizations include plans with copayments that vary widely across regions. We excluded these; we do not consider such plans to be true national plans because a fundamental characteristic (cost-sharing) varies greatly by region. However, we did include United's AARP MedicareRx, which has a third-tier copayment that varies by one dollar across regions. This is such a small variation and the plan is such an important one that we thought it worthwhile to include it.
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-
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18
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33746907886
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note
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According to Humana marketing materials, in Cook County, Illinois, the two Humana HMOs have the same copayment structure: $0/$35/ $55/25 percent for spending between $0 and $250, $10/$35/$55/25 percent for spending between $250.01 and $2,250, and 100 percent for spending between $2,250.01 and the catastrophic limit (when out-of-pocket spending reaches $3,600); the PPO differs only in the $2,250.51 to catastrophic band with a copayment structure of $10/100 percent/100 percent/100 percent; the private FFS plan differs only in the lower two bands with a copayment structure of $5/$30/$70/25 percent for spending between $0 and $2,250.
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-
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20
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33746905177
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-
note
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In these figures, an "offer" is a unique plan-region or plan-county pair. So when an insurer offers the same product in two regions (or two counties), this counts as two offers.
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21
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33746932196
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-
note
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It is by no means clear that beneficiaries have focused attention on national plans. Enrollment data, when available, will reveal which plans attracted the most beneficiaries.
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-
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22
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4243063364
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Adverse Selection and the Challenges to Stand-Alone Prescription Drug Insurance
-
Cambridge, Mass.: National Bureau of Economic Research, August
-
M. Pauly and Y. Zeng, "Adverse Selection and the Challenges to Stand-Alone Prescription Drug Insurance," NBER Working Paper no. W9919 (Cambridge, Mass.: National Bureau of Economic Research, August 2003).
-
(2003)
NBER Working Paper No. W9919
-
-
Pauly, M.1
Zeng, Y.2
-
23
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-
33746921323
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White House Threatens Veto over Changes to Medicare
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2 November
-
"White House Threatens Veto over Changes to Medicare," American HealthLine, 2 November 2005.
-
(2005)
American HealthLine
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|