The Center for Medicare and Medicaid Services (CMS) just released information on drug claims for the 25 million Medicare beneficiaries enrolled in Medicare Part D. The Medicare Part D Data Final Rule, published in May 2008 called for the compilation of this claims data (see Final Rule fact sheet) for program monitoring, research, and quality improvement.
Below are some highlights on beneficiaries’ experiences with Part D costs and benefits extracted from this 2006-2007 claims data and presented at CMS’ Medicare Prescription Drug Benefit (Part D) Symposium on October 30, 2008. Additional information on the Medicare Part D Data Final Rule and access to the power point presentations from the symposium will be available next week on CMS’ website.
Part D Costs and Utilization per Beneficiary
Based on 2006 data, the average monthly cost per enrolled beneficiary (including both beneficiary out-of-pocket costs and plan costs) was $203. The average cost was higher among stand-alone prescription drug plans (PDPs) ($233) than Medicare Advantage prescription drug plans (MA-PDs) ($135). It was also slightly higher among females ($209) than males ($193), and higher among enrollees with the low-income subsidy (LIS) ($277) than non-LIS enrollees ($147).
The average number of prescriptions per enrolled beneficiary per month was 3.2. The average number of prescriptions per enrolled beneficiary was slightly higher among PDPs (3.5) than MA-PDs (2.5), slightly higher among females (3.5) than males (2.8), and higher among the LIS (4.1) than the non-LIS enrollees (2.6).
Beneficiaries who Reached the Donut Hole Coverage Gap or Entered the Catastrophic Coverage Phase
According to CMS data, a smaller percentage of total enrollees were fully exposed to the Part D donut hole coverage gap (10.9%) as opposed to the 26% of beneficiaries reported in the recent Kaiser Family Foundation report. This smaller percentage was calculated after excluding all LIS beneficiaries as well as those non-LIS beneficiaries with some type of coverage in the gap.
When taking out these exclusions, however, CMS data actually shows a greater percentage than the KFF report – 31.7% of all enrolled beneficiaries – who fall into the donut hole.
Also, CMS found it took affected beneficiaries an average of 6 months from enrollment time to reach the donut hole. The average time in the donut hole was about 4 months. In both years, on average, LIS enrollees reached the donut hole sooner than non-LIS enrollees and PDP enrollees reached the donut hole sooner than MA-PD enrollees.
In addition, only 8.8% of all Part D enrollees reached the catastrophic coverage phase in 2007, and the vast majority were LIS beneficiaries.
See more information on Medicare Part D claims data on CMS’ website.
For information on the Part D donut hole and resources for people who are in the coverage gap, see our:
- Article “Need Help in the Part D Donut Hole? – A Review of PAPs and the Co-Pay Relief Program” and
- Resources for prescription drug savings.
For more information on the Medicare Part D benefit and extra help (LIS program) for people with low-income, visit the Part D section of our website.