P&T
Our
Other
Journal
MediMedia Managed Markets
Managed Care

 

In 2011, a third fewer nationwide Medicare PDPs

MANAGED CARE December 2010. © MediMedia USA
The Formulary Files

In 2011, a third fewer nationwide Medicare PDPs

MANAGED CARE December 2010. ©MediMedia USA

Next year there will be a total of 1,109 prescription drug plans (PDPs) offered nationwide, down nearly one third from 1,576 in 2010. The reduction can be attributed to recent regulations issued by the Centers for Medicare & Medicaid Services, which sought to eliminate duplicative plan offerings and plans with low enrollment. At the peak in 2007, there were 1,875 PDPs.

The analysis comes in a Henry J. Kaiser Family Foundation report, “Part D Plan Availability in 2011 and Key Changes Since 2006.” It says that 9 of the 16 national plan sponsors will drop at least one of their 2010 PDP offerings, in some cases because of mergers of plan sponsors.

If a beneficiary finds that his PDP has been dropped, he will be transferred automatically to one of the remaining PDPs offered by that sponsor.

Members also retain the right to select a different PDP during the open enrollment period.

More than 28 million people are enrolled in Part D plans, about 60 percent of them in PDPs, with the remainder enrolled in Medicare Advantage plans, which cover both medical services and prescription drugs. The number of PDPs per region in 2011 will range from 28 in Hawaii to 38 in Pennsylvania/ West Virginia.

In 2010, there were 41 in Hawaii and Alaska and 55 in Pennsylvania and in West Virginia, taken together.

Number of Medicare stand-alone prescription drug plans, 2006-2011

Change in plan offerings by top national plan sponsors
PDP sponsor PDPs dropped PDPs added 2011 PDP offerings
UnitedHealth Group •• 0 2 national
Universal American ••• 0 2 national
Humana ••• 2 national; one more in 27 regions
Coventry Health Care ••• 0 2 national
CVS Caremark •• 0 3 national
WellPoint 0 0 1 to 3 in each of 34 regions
WellCare Health Plans 0 0 2 near-national in 33 regions
Medco Health Solutions 0 2 national
Aetna 0 0 3 national
Cigna 0 2 national

Source for both charts: Georgetown/NORC analysis of CMS PDP landscape, 2006–2011

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014