Medicare Part D Prescription Drug Benefit

Introduction

Medicare Part D is the prescription drug benefit added to Medicare in 2006. It was created through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and provides elderly and disabled people on Medicare access to prescription drug coverage from private prescription drug plans. As of June 2006, over half of rural Medicare beneficiaries are enrolled in Part D plans.

Source:
Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging

Tools

CMS Pharmaceutical, Pharmacy, & Device Manufacturers Open Door Forums
Technical assistance
Provides information on a series of CMS forums addressing pharmacy issues. Includes call-in instructions for the next call, how to register for the mailing list, and links to pharmacy-related fact sheets.
Sponsoring organization: Centers for Medicare and Medicaid Services

Help With Medicare Prescription Drug Costs: Information for Organizations
Web site
Resources for organizations to assist in providing information to Medicare beneficiaries about extra help available for people applying for Medicare Prescription Drug coverage.
Sponsoring organization: Social Security Administration

Low Income Subsidy Outreach Toolkit
Web site
Toolkit for organizations interested in helping Medicare beneficiaries who qualify for the low income subsidy (LIS) to learn about and apply for extra help in paying for prescription drugs.
Sponsoring organization: Centers for Medicare and Medicaid Services

Medicare Health and Prescription Drug Plan Tracker
Web site
Interactive tool providing information about private plans participating in the Medicare Advantage program and the Medicare prescription drug program. Includes national statistics specific to rural areas.
Sponsoring organization: Kaiser Family Foundation

Medicare Health Plans - General Information
Web site
Information for current and future contracting Medicare Advantage Organizations, other health plans, and other parties interested in the operational and regulatory aspects of the Medicare Advantage program.
Sponsoring organization: Centers for Medicare and Medicaid Services

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
Print publication
Provides the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that passed by both Houses.

Medicare Modernization Act
Web site
Information on CMS implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Includes links to CMS fact sheets and press releases, as well as other resources for understanding the impact of the MMA.
Sponsoring organization: Centers for Medicare and Medicaid Services

Medicare Prescription Drug Coverage - General Information
Web site
Links to important information on the new Medicare prescription drug benefit. Includes prescription drug benefit pharmacy training information.
Sponsoring organization: Centers for Medicare and Medicaid Services

Medicare Prescription Drug Coverage Outreach Toolkit
Print publication
Designed to equip community-level organizations with the materials needed to provide information and assistance to their clients on the Medicare prescription drug coverage.
Sponsoring organization: Centers for Medicare and Medicaid Services

Medicare Prescription Drug Plan Finder
Web site
Online tool for identifying and enrolling in Medicare prescription drug plans. Includes information about plans available in each state. Available in Spanish.
Sponsoring organization: Centers for Medicare and Medicaid Services

Medicare Resource Kit
Web site
Links to technical information and press releases on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Sponsoring organization: U.S. House of Representatives

Medicare RX: National Conversation-Friends and Family First
Web site
Aids faith-based and community organizations working with individuals eligible for the Medicare prescription drug benefit. Describes five steps to select a Medicare prescription drug plan.
Sponsoring organization: Centers for Medicare and Medicaid Services

Medicare.gov
Database
Searchable database on a host of Medicare related tools, including prescription drug plans, publications, and nursing home comparing.
Sponsoring organization: Centers for Medicare and Medicaid Services

MedlinePlus: Medicare Prescription Drug Plan
Web site
Links to resources, tools and news related to the Medicare prescription drug plan (Part D).
Sponsoring organization: National Library of Medicine

Prescription Drug Coverage Information for Partners
Web site
Outreach resource materials and information for organizations working to inform people about Medicare's new outpatient prescription drug coverage.
Sponsoring organization: Centers for Medicare and Medicaid Services

Rural Health Research: Medicare Part D
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Medicare Part D, produced by the Office of Rural Health Policy's funded rural health research centers.
Sponsoring organization: Rural Health Research Gateway

Maps & Map Collections

Percent of Rural Persons Enrolled in Medicare Part D Plans, June 2006
Geographic coverage: United States
Shows the percent of rural people enrolled in a Medicare Part D prescription drug program as of June 2006, based on data from the Centers for Medicare and Medicaid Services.
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Date: 2006

Regulations, Forms & Other Useful Documents

2008 Medicare Advantage (MA), Medicare Advantage-Prescription Drug (MA-PD), Cost-Based Plan, and Stand Alone Prescription Drug Plan (PDP) Call Letter
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information for health plans regarding how to implement CMS policies and procedures and comply with critical program requirements for the 2008 contract year. Includes detailed information on the Medicare Advantage (Part C) and prescription drug (Part D) programs.
Date: 04 / 2007

April 2009 Rural Enrollment in Medicare Advantage: Growth in PPO Plans Outpacing Growth in PFFS Plans
Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Reports that private fee-for-service (PFFS) plans dominate enrollment in rural areas and have accounted for much of the program's expansion since 2005. However, from December 2008 through April 2009 enrollment growth of preferred provider organization (PPO) plans, both nationally and in rural areas, was double the enrollment growth of PFFS plans.
Date: 05 / 2009

Eligible But Not Enrolled? Potential for Targeting Over a Half-Million Rural Medicare Beneficiaries for Enrollment in the Low-Income Subsidy Prescription Drug Program (Policy Brief)
Author(s): Timothy D. McBride, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Discusses the Medicare Part D low-income supplement (LIS), which is designed to help low-income persons access the prescription drug benefit with reduced premiums and lower out-of-pocket costs.
Date: 12 / 2008

Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United States. Updates findings presented in RUPRI Center Policy Brief PB2006-8.
Journal citation: RUPRI Rural Policy Brief Volume 12 Issue 1
Date: 01 / 2007

Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
The findings from this study, along with specific suggestions made by pharmacists during the interviews, suggest short-term actions that can be taken to address the challenges faced by rural independent pharmacies who are the sole providers in their communities. A joint publication of the North Carolina Rural Health Research & Policy Analysis Center and the RUPRI Center for Rural Health Policy Analysis.
Date: 11 / 2006

Impact of the Medicare Drug Benefit on Health Care Spending by Older Households
Author(s): Dean Baker, Ben Zipperer
Sponsoring organization: Center for Economic and Policy Research
Examines the extent to which the Medicare drug benefit reduced the burden of health care costs for seniors in 2006, the first year in which it was in effect, using data from the Bureau of Labor Statistics Consumer Expenditure Survey.
Date: 12 / 2008

Information for HRSA Grantees on Medicare and Pharmacy Services
Sponsoring organization: Office of Rural Health Policy
Includes key messages for HRSA Grantees, along with links and information about Medicare Part D reimbursement.
Date: 05 / 2006

Medicare Advantage
Author(s): Paulette C. Morgan
Sponsoring organization: Congressional Research Service
An overview of the Medicare Advantage program, and includes legislative history, analysis of recent trends and includes rural issues.
Date: 03 / 2009

Medicare Advantage in 2008
Author(s): Marsha Gold
Sponsoring organization: Kaiser Family Foundation
Analyzes recent developments in the Medicare Advantage marketplace, including plan choices available to beneficiaries and enrollment trends by plan type and geography including rural issues.
Date: 06 / 2008

Medicare Beneficiaries’ Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans
Author(s): Victoria A Freeman, Indira Richardson, Rebecca T. Slifkin
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Describes pharmacy Prescription Drug Plan (PDP) contract patterns of sole rural pharmacies. Addresses PDP enrollment choices of Medicare Part D enrollees.
Date: 01 / 2009

Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Early information on enrollment in the Medicare prescription drug program in rural and urban areas. Includes findings from an analysis of plans available to rural persons under Medicare's Part D program.
Date: 04 / 2006

Medicare Payment Basics: Medicare Advantage Program Payment System
Sponsoring organization: Medicare Payment Advisory Commission
Overview of Medicare payments to Medicare Advantage (MA) plans. Includes information on Medicare Advantage regions.
Date: 10 / 2008

Medicare Payment Basics: Part D Payment System
Sponsoring organization: Medicare Payment Advisory Commission
Overview of the Medicare Part D prescription drug benefit. Includes information on Medicare subsidies, Medicare payments to plans, and the calculation of enrollee premiums.
Date: 10 / 2008

Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals
Sponsoring organization: Centers for Disease Control and Prevention
Offers general information about certain aspects of the Medicare program including enrollment, reimbursement, payment policies, evaluation and management services, protecting the Medicare Trust Fund, and inquiries, overpayments and fee-for-service appeals.
Date: 10 / 2009

Medicare Prescription Drug Benefit (Fact Sheet)
Sponsoring organization: Kaiser Family Foundation
Provides information and data about the Medicare Drug Benefit, including a breakdown of the standard benefit and updates on additional low-income assistance.
Date: 02 / 2008

Medicare Prescription Drug Benefit (Fact Sheet)
Sponsoring organization: Kaiser Family Foundation
Provides information and data about the Medicare Drug Benefit, including 2009 plan information, a breakdown of the standard benefit, updates on additional low-income assistance, and the latest available enrollment data
Date: 11 / 2009

One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A findings brief is also available.
Date: 09 / 2007

One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A final report is also available.
Date: 10 / 2007

Prescription Drug Spending and Coverage Among Rural Medicare Beneficiaries in 2003
Author(s): Craig Caplan, Normandy Brangan
Sponsoring organization: AARP Public Policy Institute
Examines out-of-pocket spending on prescription drugs by noninstitutionalized rural Medicare beneficiaries age 65 and older. Includes information on supplemental insurance coverage among rural and urban Medicare beneficiaries.
Date: 2004

Retail Pharmacy Participation in Medicare Part D Prescription Drug Plans in 2006
Author(s): Daniel R. Levinson
Sponsoring organization: U.S. Department of Health and Human Services
Office of Inspector General report discussing the extent to which retail pharmacies participate in Medicare Part D stand-alone prescription drug plans (PDPs). Includes comparison of pharmacy participation rates among metropolitan and non-metropolitan pharmacies.
Date: 06 / 2007

Review of the Relationship between Medicare Part D Payments to Local, Community Pharmacies and the Pharmacies' Drug Acquisition Costs
Author(s): Office of Inspector General
Sponsoring organization: U.S. Department of Health and Human Services
Analyzes the relationship between Medicare Part D payments, excluding dispensing fees, to local, community pharmacies and the pharmacies’ drug acquisition costs. Estimate Part D dispensing fees and compares them with Medicaid dispensing fees. Includes some data specific to rural pharmacies.
Date: 01 / 2008

Rural Enrollment in Medicare Advantage Continues to Grow Rapidly in 2008, Led by Private Fee-for-Service Plans
Author(s): Yolonda Y. Campbell, Timothy D. McBride, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides findings about enrollment in the Medicare Advantage program in rural areas and across the United States.
Date: 08 / 2008

Rural Enrollment in Medicare Advantage: Growth Slows in 2008
Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Reports that rate of growth of rural enrollment in the Medicare Advantage program decreased significantly in 2008, compared to previous years. In addition, the growth rate in preferred provider organization plans in rural areas now exceeds that in private fee-for-service plans.
Date: 03 / 2009

Rural Enrollment in Medicare Part D is Growing Slowly
Author(s): Timothy D. McBride, Leah Kemper, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Reports that rural beneficiaries are more likely to enroll in stand-alone prescription drug plans (PDPs), while urban beneficiaries are much more likely to enroll in Medicare Advantage (MA) plans that offer prescription drug coverage (MA-PD plans).
Date: 03 / 2009

Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
Author(s): Curt Mueller, Keith Mueller, Janet Sutton
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Identifies sections of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) that might be of special concern to rural Medicare beneficiaries, medical care providers, and policymakers. Includes guidance regarding provisions in the Proposed Rule "Establishment of the Medicare Advantage Program," which implements Title II of the MMA, with a focus on its impact on rural health service delivery.
Date: 08 / 2004

Side-by-Side Comparison of Key Medicare Provisions in 2009 Health Reform Legislation
Sponsoring organization: Kaiser Family Foundation
Describes the major Medicare provisions relating to benefit changes, Medicare Advantage, the Medicare prescription drug benefit, physician and other provider payment reforms, and other health system reforms in the Senate Finance proposal and the House Tri-Committee bill.
Date: 09 / 2009

Terms & Acronyms

Enrollment Period For Medicare Part D, those already on Medicare can enroll in the drug benefit between November 15 and December 31, and coverage would be effective on January 1 of the new year. If you were first eligible to enroll before May 15, 2006 but did not sign up, you may need to pay a late enrollment penalty.

Medicare Advantage A type of Medicare plan offered by a private insurance company that contracts with Medicare to provide Medicare Part A and Part B benefits. Also called Part C or Medicare + Choice, Medicare Advantage Plans are HMOs, PPOs, Private Fee-for-Service Plans, or Medicare Medical Savings Account Plans. For beneficiaries enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, and are not paid for under the Original Medicare Plan.

Medicare Advantage Prescription Drug Plan (MA-PD) Medicare Advantage Plans that offer prescription drug coverage in additional to Medicare Part A and Part B benefits.

Medicare Part D Prescription drug benefit added to Medicare in 2006. Created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

Medicare Prescription Drug Plan (PDP) A Medicare program that provides prescription drug coverage as a supplement to traditional fee-for-service Medicare. The stand-alone drug plans are offered by insurers and other private companies to beneficiaries enrolled in Original Medicare.

Medigap A Medicare supplement insurance policy sold by private insurance companies to fill gaps in Original Medicare Plan coverage.

True Out-of-Pocket Costs (TrOOP) Drug costs paid by a Medicare enrollee, or on behalf of an enrollee by a family member, charitable organization, or State Pharmacy Assistance Program.

Article Searches & Bibliographies

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