Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

States will play a key role in the new Medicare prescription drug benefit. This includes financing much of the drug costs for low-income seniors and persons with disabilities. Here is some useful information for state leaders: - Implications of the New Medicare Prescription Drug Benefit for State Medicaid Budgets. From...
Under the Medicare Modernization Act (MMA), the new Medicare prescription drug benefit (aka, Medicare Part D) includes a retiree subsidy to encourage the continuation of employer-sponsored drug plans for retired Americans. Here are some excellent resources to help employers understand the Medicare retiree subsidy: - White Paper on Retiree Drug Coverage...
State Medicaid programs are the nation's largest buyers of prescription drugs, serving over 50 million Americans, including the most vulnerable and costly patients. However, Medicaid drug benefits are complex and vary from state to state and among the diverse populations served. We now have an wealth of new information on...
To help organizations planning to submit bids to serve beneficiaries under the new Medicare prescription drug benefit, the Centers for Medicare & Medicaid Services (CMS) has posted a wealth of valuable new information on it's website. Designed to help potential drug plan bidders better understand and estimate the Medicare population's...
Medicaid health plans are the Ginger Rogers of managed care. They have to do everything commercial and Medicare health plans do but have to do it backwards and in high heels. Despite dealing with more complex requirements and the toughest, most vulnerable patient populations, Medicaid health plans often provide...
Under Medicare's new prescription drug benefit, employers will have several options for maintaining drug coverage for their retirees. Staff at the Centers for Medicare & Medicaid Services (CMS) created a detailed briefing for employers, unions, health benefit consultants, and others interested in understanding the options, including the new retiree...
Pharmacy benefit managers (PBMs) already administer Rx benefits for most employers and several Medicaid programs. Medicare's voluntary prescription drug benefit, set to begin in 2006, creates a huge new market opportunity for PBMs. However, the Medicare drug benefit will also create significant new challenges to PBMs and other organizations...
A new report projects the savings to Medicare beneficiaries who sign up for Medicare's new prescription drug benefit in 2006. Prepared by the Actuarial Research Corporation (ARC) for the Kaiser Family Foundation, the report estimates that: - Low-income beneficiaries who sign up for Medicare drug plans and receive the new...
Under the new Medicare prescription drug benefit, drug plans will have a fair amount of discretion in setting formularies. The idea is to encourage competition among drug plans and offer Medicare beneficiaries choice. The Centers for Medicare & Medicaid Services (CMS) will review the benefit designs of drug plan...
Prescription drug utilization varies dramatically among individuals. To make sure Medicare payments to Prescription Drug Plans (PDPs) reflect the health status of enrollees, the Centers for Medicare & Medicaid Services (CMS) is developing a risk adjustment methodology. Risk adjustment is a statistical process used to identify and adjust for...

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