Ken Goldberg Medicare Support Services Express Scripts, Inc.

1
Ken GoldbergMedicare Support ServicesExpress
Scripts, Inc.
Medicare Part D
2
Purpose of Todays Meeting

• A brief history and overview of Part D
• Medicare Part D Standard Benefit
• Recommended Course of Action
• Review 2006 Objectives
• Present Your Options
• Review Timeline
• Q As

3
Medicare in Review

• Currently, Medicare, provides coverage to
  approximately 40 million Americans.
• Part A - Hospital Insurance
• Part B - Supplementary Medical Insurance
• Part C - Medicare Choice now Medicare
  Advantage
• Part D - Prescription drug coverage for Medicare
  beneficiaries (Basic and Catastrophic)
• Medicare Who is eligible?
• People age 65 or older
• Some people under age 65 with disabilities
• People with End-Stage Renal Disease (ESRD), which
  is permanent kidney failure requiring dialysis or
  a kidney transplant

4
Medicare Part D Standard Benefit
5 co-ins
95 Plan Contribution
5,100
3,600
100 Enrollee Payment Donut Hole
Total Drug Expenditures
Enrollee Out-of-Pocket Expenses
2,250
750
25 co-ins
75 Plan Contribution (1,500 total)
250
250
250 Enrollee Deductible
0
0
420 in annual premiums
Beneficiarys Out of Pocket
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Key Objectives for State Employers

• Reduce spend
• Minimize retiree disruption
• Minimize administrative burden
• Avoid inherent risks of first year
• Maintain flexibility for future Not Just for
  2006

Generate certain significant savings today with
little/no changes while positioning for 2007 and
beyond.
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4 Options for State Employers

• Continue Your Current Rx Benefit
• Take the Subsidy
• Offer Credible Coverage
• Become a PDP (Not available for 2006)
• Participate in a PDP
• Offer a Wrap

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Options Objectives
Employer PDP
PDP
Subsidy
Wrap
Reduce spend
Minimize retiree disruption Minimize
administrative burden Avoid risk of first-year
program Maintain flexibility for future
8
Options Objectives
Employer PDP
PDP
Subsidy
Wrap
Reduce spend
Minimize retiree disruption Minimize
administrative burden Avoid risk of first-year
program Maintain flexibility for future
9
Options Objectives
Employer PDP
PDP
Subsidy
Wrap
Reduce spend
RETIREE
EMPLOYER

• Employer requests waiver of Part D requirement to
  limit enrollment or make other changes
• Medicare pays employer-sponsored PDP or MA plan
  for Medicare coverage

Minimize retiree disruption Minimize
administrative burden Avoid risk of first-year
program Maintain flexibility for future
Retiree is enrolled in a qualified PDP or MA
plan offered only to members of an employer group
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Options Objectives
Employer PDP
PDP
Subsidy
Wrap
Reduce spend
RETIREE
EMPLOYER
Retiree is enrolled in a qualified PDP or MA plan
Minimize retiree disruption Minimize
administrative burden Avoid risk of first-year
program Maintain flexibility for future

• Employer contracts with a provider for a PDP for
  their members only
• Medicare pays PDP on behalf of employer-sponsored
  PDP or MA plan for Medicare coverage

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Options Objectives
Employer PDP
PDP
Subsidy
Wrap
Reduce spend
RETIREE
EMPLOYER

• Employer provides supplemental coverage to
  Standard Benefit
• Medicare pays PDP or MA plan for coverage
• Employer provides claims data for assessment of
  retirees True Out of Pocket (TROOP)

Retiree is enrolled in a qualified PDP or MA plan
Minimize retiree disruption Minimize
administrative burden Avoid risk of first-year
program Maintain flexibility for future
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TrOOP Process
Plan StatsPrimary Coverage 25Secondary
Coverage 15Member Copay 10
TrOOPFacilitator
10.00
Batch for now
10.00
15.00
15.00
25.00
CMS will provide 2nd
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Options Objectives
Employer PDP
PDP
Subsidy
Wrap
vv
vv
v
v
Reduce spend
Minimize retiree disruption Minimize
administrative burden Avoid risk of first-year
program Maintain flexibility for future
v
vv
vv
v
v
v
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Options Objectives
Employer PDP
PDP
Subsidy
Wrap
v
v
Reduce spend

• EXPRESS SCRIPTS RECOMMENDATIONS FOR 2006
• If you qualify for the subsidy, TAKE IT.
• If you dont qualify, UPDATE so you do.
• Regardless, position yourself for possible
  changes in 2007.

Minimize retiree disruption Minimize
administrative burden Avoid risk of first-year
program Maintain flexibility for future
v
v
v
v
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Subsidy Checklist

• Finalize Plan Design for 2006
• Engage an Actuary
• Communicate to your retirees that you are
  offering Creditable Coverage
• By September 30th , Submit to CMS
• Subsidy Application
• Actuarial Attestation
• Eligibility Report
• By November 15th , send letter of Creditable
  Coverage to Medicare eligible beneficiaries

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MMA Part D Timeline --- Tight!
Non-employer MA-PD or PDP timelines
Intent to participate
Formularies due 4.22
Bids due 6.6
Application Due 3.25
RDS Website opens
Waivers
Forms for retiree subsidy
L I V E
Guidance on AE
Guidance on data submissions and payment for
subsidy
Creditable coverage notice guidelines issued
Subsidy Attestation DUE 9.30
Beneficiaries enroll
Employer PDP Intent due
Employer PDP Bids due 7.1
Employer PDP Appl Due 4.25
Empl PDP formularies due 6.6
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Thank You
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CMS Planned Print Products for 2005
May
June
August
September
October

• Bifold What Friends Family Need to Know about
  Medicare Prescription Drug Coverage
• Fact Sheets Basics Creditable Coverage
  Employer/Union Coverage
• Mailing to those who automatically qualify for
  extra help

• Medicare You 2006 (fixed)
• Welcome to Medicare Initial Enrollment Package
• Your Guide to Medicare Prescription Drug Plans

• Tip Sheet How to Compare Plans
• Tip Sheet How to Enroll in a Plan

• Medicare You pre-mailing
• Rx card transition enrollee letter

• Medicare You (2006)
• Tip Sheet How to File a Prescription Drug
  Coverage Complaint / Appeal
• Tip Sheet How to Use the Medicare Prescription
  Drug Plan Finder Web Tool

• All titles are working titles
• All dates are estimates
• All dates are for when content is final

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Resources

• CMS Website
• www.cms.hhs.gov
• Retiree Drug Subsidy Information
• www.rds.cms.hhs.gov