Medicare Modernization Act Overview

1
Medicare Modernization Act Overview
Presidents Advisory Council on
HIV/AIDS (PACHA) Monday, June 20, 2005

• Abby L. Block
• Senior Advisor to the Administrator of the
  Centers for Medicare and Medicaid Services

2
MMA Overview

• Medicare Prescription Drug, Improvement, and
  Modernization Act of 2003 (Public Law 108-173)
  passed December 8, 2003.
• 2004-2005
• Prescription Drug Card
• Enhanced Medicare Advantage Plan Options
• January 2005
• Preventive Benefits
• January 2006
• Prescription Drug Benefit
• Low Income Subsidy Application (June 2005)
• Enrollment Begins November 15, 2005
• New Medicare Advantage Plan Options

3
KEY DATES

• June 6
• Final Bids Submitted
• October
• Plan Marketing Starts
• Medicare and You Handbook Available
• Dual Eligible Beneficiaries Assigned to Plan
• Specific Plan Information Available
• November 15
• Open Enrollment Begins
• May 15, 2006
• Open Enrollment Ends

4
Medicare Prescription Drug Standard Benefit

• 250 beneficiary deductible
• Medicare will pay 75 of drug costs up to 2,250
• The beneficiary will pay 25 of these costs
• Beneficiary will pay 100 of drug costs between
  2,250 and 5,100 (3,600 out-of-pocket)
• After 3,600 in out-of-pocket spending, Medicare
  will pay approximately 95

5
No gaps for Beneficiaries with income up to 135
FPL

• Only the area in red must be paid by the
  individual.
• Total out-of-pocket is the sum of the 2/5
  copays for up to 5100 worth of prescriptions

6
Road to ImplementationProgress Made,Where we
are,and Whats ahead

7
PDP Regions Announced

• MMA directed the Secretary to establish PDP
  regions. This process was separate from the final
  regulation.
• On December 6, 2004, CMS announced the
  establishment of 26 MA regions and 34 PDP
  regions.

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Establishment of PDP Regions
ME
WA
ND
MT
VT
NH
MN
NY
OR
MA
WI
SD
ID
CT
MI
RI
WY
NJ
PA
IA
OH
DE
NE
IN
MD
IL
NV
UT
WV
DC
VA
CO
MO
KS
KY
CA
NC
TN
SC
OK
AR
NM
AZ
AL
GA
MS
LA
TX
AK
FL
HI
Note Each territory is its own PDP region.
9
Guidance Released

• LTC Guidance
• Transition Process Guidance
• Fiscal Solvency Standards
• Prescription Drug Event Data
• Employer waiver guidance

10
Formulary Guidance

• 6 Drug Classes of special interest
• Anticonvulsants
• Antipsychotics
• Antidepressants
• Chemotherapy
• HIV/AIDS Drugs
• Immunosuppressants

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HIV/AIDS Drugs on Every Formulary

• Stavudine
• Tenofovir
• Zalcitabine
• Zidovudine
• Amprenavir
• Atazanavir
• Fosamprenavir
• Indinavir
• Lopinavir and Ritonavir
• Nelfinavir
• Ritonavir
• Saquinavir

• Enfuvirtide
• Delavirdine
• Efavirenz
• Nevirapine
• Abacavir
• Abacavir, Lamivudine, and Zidovudine
• Abacavir/Lamivudine
• Didanosine
• Emtricitabine
• Emtricitabine and Tenofovir
• Lamivudine
• Lamivudine and Zidovudine

12
Part D Goals

• Access To ensure that plans are available
  nationwide-both Prescription Drug Plans and
  Medicare Advantage
• OperationsTo ensure that plans provide high
  quality service to beneficiaries and are able to
  operate effectively
• Education, Outreach, and EnrollmentTo ensure 42
  million Medicare beneficiaries can make confident
  decisions on their prescription drug coverage.

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Implementation and Outreach

• Educate 42 million Medicare Beneficiaries so they
  can make confident choices on prescription drug
  coverage
• Target Populations
• General- Seniors/People with disabilities
• Low Income
• Retirees
• Medicare Advantage

14
Beneficiaries Need Targeted Support

• Millions
• Medicare Advantage Enrollees 5.7
• People with Retiree Coverage 11.8
• People with Medicaid 6.3
• Other People with Limited Means 7.7
• Remaining General Population 11.0

Total 42.5
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Communication Goals

• Increase of following
• Beneficiaries awareness of Medicare drug coverage
• Beneficiaries belief that the Medicare benefit
  has a positive impact on their lives
• Beneficiaries understanding the need to make a
  decision regarding enrollment
• Beneficiaries have taken action regarding
  Medicare drug coverage
• Actual enrollment

16
President Bush Kicked-off Awareness Campaign

• On Thursday, June 16th President Bush visited HHS
  to begin the Nationwide awareness drive
• President Bush urged everyone on Medicare to sign
  up.
• President Bush and Secretary Leavitt visited
  Minnesota on Friday, June 17th to continue the
  focus on Medicares new benefits.

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General Campaign Messages

• Every Medicare beneficiary will be eligible for
  drug coverage that will help you pay for the
  prescriptions you need.
• The coverage will pay for both brand name and
  generic drugs.
• You will have a choice of at least two plans.
• There will be additional assistance for those in
  need.

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Targeted Messages

• Medicare Advantage Enrollees You will get more
  drug coverage through your health plan.
• Retirees with Good Coverage Your drug coverage
  can get new support from Medicare.
• People with Medicaid You will get comprehensive
  coverage from Medicare.
• Other People with Limited Means You need to
  apply for low-income subsidy for comprehensive
  coverage.
• Remaining General Population This is an
  insurance program. You need to enroll for help
  with current drug costs and for future peace of
  mind. Save by enrolling on time.

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Timeline

• June-September 2005 Awareness Limited Income
  Enrollment
• Build awareness, including national grassroots
  education campaign
• Low-income subsidy applications available
• Community events on low-income subsidy and on
  drug benefit
• Retirees enrolled and informed
• October 2005 Support for Prescription Drug Plan
  Enrollment
• Medicare You Handbook mailed to all
  beneficiaries
• Specific plan information available, plans start
  marketing
• People with Medicaid notified about Medicare plan
  enrollment
• Support enrollment through grassroots education
  and counseling
• November 15, 2005 Open Enrollment Period Begins
• January 1, 2006 Prescription Drug Coverage
  Starts
• May 15, 2006 Open Enrollment Period Ends
• You pay more if you enroll later, just like any
  other insurance

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Ongoing Training and Assistance for Plan Sponsors

• Weekly calls through June
• Submitting claims data for Part D
• July 18-20th in Baltimore
• July 26-28 in Las Vegas
• August 1-3 in Chicago
• August 9-11 in New Orleans
• Payment and enrollment conference
• August 29th September 2nd in Baltimore
• RDS National Conference
• July 12 13, 2005 in Dallas, TX.

21
Field Operations

• National Strategy/Local Execution
• Community Network
• Layered/Coordinated Outreach
• Partners by target with application materials
• National partner/drill down to local affiliates
• Timeline/Coordination with SSA

22
Partnerships

• Are critical to success of drug benefit program
• Allows CMS to work with organizations trusted by
  beneficiaries
• Helps CMS to focus information to specific
  audiences
• CMS and its many partners share the common goal
  of helping people with Medicare get answers and
  make better informed health care decisions

23
Collaboration HIV/AIDS Partners HHS

• Coordination between National Level, CMS Regional
  Offices, SSA Local Offices, States
• Example Train the Trainer Activities
• Facilitate Information Dissemination
• State AIDS Directors
• HIV/AIDS-Specific Medical Providers
• HIV/AIDS Pharmacies
• HHS/CMS to Participate in National HIV/AIDS
  Conferences

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Conclusion

• CMS has made great strides to implement the drug
  benefit.
• We encourage flexibility and are willing to work
  with partners as we move forward.
• We have established a variety of mechanisms to
  answer questions, including training events, web
  materials, user group calls, and a Q A database