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98% of Prescription Drug Plans Place a Prior Authorization on At Least 1 of the 100 Drugs Most Frequently Prescribed To Medicare Beneficiaries.

DUBLIN, Ireland -- Research and Markets ( has announced the addition of the new report from Decision Resources Inc, "Medicare Part D: Strategies of the Leading Health Plans" to their offering.

Since its creation in 1965, the Medicare program has become a major source of health care coverage for seniors, the disabled, and patients with end-stage renal disease End-stage renal disease (ESRD)
Total kidney failure; chronic kidney failure is diagnosed as ESRD when kidney function falls to 5-10% of capacity.

Mentioned in: Chronic Kidney Failure

end-stage renal disease 
 in the United States. Historically, however, Medicare offered only limited coverage of prescription medicines. To improve beneficiaries' access to outpatient prescription medicines, the Medicare Prescription Drug, Improvement, and Modernization Act The Medicare Prescription Drug, Improvement, and Modernization Act (Pub.L. 108-173, 117 Stat. 2066, also called Medicare Modernization Act or MMA) is a law of the United States which was enacted in 2003.  of 2003 (commonly known as the Medicare Modernization Act, or MMA (Microcomputer Managers Association, Inc.) A membership organization with chapters throughout the U.S. that was devoted to educating personnel responsible for personal computers. It disbanded in 1996.

Mma - A fast Mathematica-like system, in Allegro CL by R. Fateman, 1991.
) introduced Medicare Part D--a new outpatient drug benefit that began operation on January 1, 2006. This report analyzes the Medicare Part D strategies of the leading health plans. We begin with a review of the key features of the Part D benefit design and the main sources of Medicare drug benefit coverage. We then examine how six leading health plans--UnitedHealth Group, Humana, WellPoint, MemberHealth, WellCare, and Kaiser Permanente--are approaching Medicare Part D. We conclude with a brief assessment of the outlook for the Medicare prescription drug benefit.

Business Implications:

The early success of the leading players in Medicare Part D is attributable not only to their marketing expertise but also to their good fortune in being automatically assigned hundreds of thousands of Medicare-Medicaid dual eligible beneficiaries. They achieved this advantage by setting their premiums below benchmark levels in many states. The Centers for Medicare and Medicaid Services The Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and  (CMS (1) See content management system and color management system.

(2) (Conversational Monitor System) Software that provides interactive communications for IBM's VM operating system.
) will monitor health plans closely and is unlikely to renew contracts with plans it judges to have a deficient benefit design. Furthermore, enrollees could be lured away by other plans that offer more-attractive benefits.

Several leading health plans have openly stated that their longer-term ambition in the Part D market is to transfer as many members as possible from their stand-alone prescription drug plans (PDPs) to their Medicare Advantage (MA) plans, where they can achieve much more substantial margins. If these companies can demonstrate their credentials by means of their PDPs, members may be prepared to sign up for MA plans. As a result, the balance of the Part D market could shift from PDPs to MA plans over time.

An analysis of CMS data shows that 98% of PDPs place a prior authorization or step therapy restriction on at least 1 of the 100 drugs most frequently prescribed to Medicare beneficiaries; 12 plans (1%) restrict more than 40 of these medicines. Sixty-six percent of PDPs have restrictions on 6 or more of the top 100 drugs. On average, Medicare PDPs include 93.5 of the top 100 drugs in their formularies and subject 9.5 of these medicines to prior authorization or step therapy restrictions.

UnitedHealth Group, the leading player in Medicare Part D, has what is generally regarded as the crown jewel of partnerships: an exclusive Part D marketing arrangement with AARP AARP, a nonprofit, nonpartisan national organization dedicated to "enriching the experience of aging"; membership is open to people age 50 or older. Founded in 1958 by Ethel Percy Andrus as American Association of Retired Persons, AARP now has over 30 million  (formerly the American Association of Retired Persons American Association of Retired Persons: see AARP. ), an organization that represents 35 million seniors in the United States. The AARP product accounts for more than 90% of United's individual enrollment in Medicare Part D.

Humana, the second-ranked company in this market, owes its early success in the PDP (1) (Plasma Display Panel) See plasma display.

(2) (Policy Decision Point) See COPS and XACML.

(3) (Programmed Data P
 market in large measure to its low-pricing strategy. In 19 states, the company offers the only PDP with a premium of less than $20 per month; in another 14 states, it is one of only two insurers to offer premiums below that price. However, Humana can also offer its members a full array of Medicare products--HMOs, regional and local PPOs, and private fee-for-service plans--at a range of price points and benefit levels.

Key Topics Covered Include:

- Overview

- Part D Benefit Design

- Sources of Medicare Drug Benefit Coverage

- Strategies of the Leading Health Plans

- Key Trends and Outlook

Companies Mentioned Include:

- Blue Cross Blue Shield of Michigan

- Torchmark Corporation

- CIGNA CIGNA CG (Connecticut General Life Insurance Company) INA (Insurance Company of North America)  

- Sierra Health Services

- QCC Insurance Company

- Longs Drug Stores Corporation

- Health Care Service Corporation

- Wellmark

- SCAN Health Plan SCAN (SCAN Health Plan) is an SHMO founded in Long Beach, CA in 1977. SCAN was formerly known as Senior Care Action Network. External links
  • SCAN Health Plan

- MMM MMM Myeloid metaplasia with myelofibrosis, see there  Healthcare

- Health Net

- HIP, Health Plan of New York

- Aetna

- Medco Health Solutions Medco Health Solutions, Inc. (NYSE: MHS) is a leading pharmacy benefit manager (PBM) company based in Franklin Lakes, New Jersey. The current chairman is David Snow. The company formed in August 2003 as a spinoff from Merck & Co..  

- Caremark

- Universal American Financial Corporation

- Coventry Health Care Coventry Health Care, Inc. (Coventry) (NYSE: CVH) is a managed health care company in the United States. On February 8th of 2007 Coventry agreed to acquire Concentra's Workers Compensation Managed Care Services Businesses. External links
  • Company website

- WellCare Health Plans

- MemberHealth

- WellPoint

- Humana

- UnitedHealth-PacifiCare

- Kaiser Permanente

- Empire HealthChoice Assurance

- NewQuest Health Solutions

For more information visit
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Date:Aug 2, 2006
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