if you want to remove an article from website contact us from top.

    ms. gates has recently become dually eligible for medicare and medicaid. she is very concerned about how this will affect her prescription drug coverage. what should you tell her?

    James

    Guys, does anyone know the answer?

    get ms. gates has recently become dually eligible for medicare and medicaid. she is very concerned about how this will affect her prescription drug coverage. what should you tell her? from EN Bilgi.

    AHIP2019 Questions

    For 2020 AHIP We did a much better job - We posted Questions and Answers of all 5 Modules in the order asked and We posted 2020 AHIP Questions and Answers. I got a 6 wrong answers / 88%/ so I have to take the test again. - If a reader to can help me find the 6 wrong answers it would be appreciate...

    AHIP2019 Questions

    By AHIP2019,

    October 16, 2018 in Insurance Agent Forum

    Archived

    This topic is now archived and is closed to further replies.

    This topic is now closed to further replies.

    Go to topic listing

    Source : www.naaip.org

    Special enrollment periods if you get Extra Help

    Learn about special enrollment periods for Medicare Advantage Plan or Medicare prescription drug coverage.

    Special enrollment periods if you get Extra Help

    I'm eligible for both Medicare and Medicaid.

    I qualify for Extra Help paying for Medicare drug coverage.

    I'm enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.

    Source : www.medicare.gov

    The Effect of Transitioning to Medicare Part D Drug Coverage In Seniors Dually Eligible for Medicare and Medicaid

    In January, 2006, patients dually eligible for Medicaid and Medicare (Dual Eligibles) were automatically enrolled in Medicare Part D prescription drug plans. This transition affected formulary coverage for many patients, causing widespread concern about ...

    J Am Geriatr Soc. Author manuscript; available in PMC 2009 Dec 1.

    Published in final edited form as:

    J Am Geriatr Soc. 2008 Dec; 56(12): 2304–2310.

    doi: 10.1111/j.1532-5415.2008.02025.x

    PMCID: PMC2607038 NIHMSID: NIHMS75675 PMID: 19093930

    The Effect of Transitioning to Medicare Part D Drug Coverage In Seniors Dually Eligible for Medicare and Medicaid

    William H. Shrank, MD, MSHS,1 Amanda R. Patrick, MS,1 Alex Pedan, PhD,2 Jennifer M. Polinski, MPH,1 Laleh Varasteh, RPh, MSF,2 Raisa Levin, MS,1 Nan Liu,2 and Sebastian Schneeweiss, MD, ScD1

    Author information Copyright and License information Disclaimer

    The publisher's final edited version of this article is available at J Am Geriatr Soc

    See other articles in PMC that cite the published article.

    Associated Data

    Supplementary Materials

    Go to:

    Abstract

    Objectives

    In January, 2006, patients dually eligible for Medicaid and Medicare (Dual Eligibles) were automatically enrolled in Medicare Part D prescription drug plans. This transition affected formulary coverage for many patients, causing widespread concern about compromised access to essential medications. We evaluated medication use, out-of-pocket spending and medication switching during the transition period for Dual Eligibles.

    Setting and Participants

    We used patient-level pharmacy dispensing data for Dual Eligibles older than 65 from January 2005 to December 2006 from a large pharmacy chain with stores in 34 states.

    Design and Measurements

    Changes in utilization, patient copayments, and medication switching were analyzed using interrupted time trend analyses. We evaluated utilization and spending for five study drugs: clopidogrel, proton pump inhibitors, warfarin, and statins (essential drugs covered by Part D plans) and benzodiazepines (not covered through Part D, but potentially covered through Medicaid).

    Results

    Drug use for 13,032 Dual Eligibles was evaluated. There was no significant effect of the transition to Medicare Part D on use of all study drugs, including the uncovered benzodiazepines. Cumulative reductions were seen in copayments for all covered drugs after implementation of Part D, ranging from 25% annually for PPIs to 53% for warfarin. However, there was a larger increase in copayments, 91% annually, for benzodiazepines after the transition. We found a 3.0 times greater rate of switching medications for the proton pump inhibitors, but no significant change in the other study drug classes.

    Conclusion

    These findings in a single, large pharmacy chain indicate that the transition plan for Dual Eligibles led to less medication discontinuation and switching than many had expected. The substantially increased cost-sharing for benzodiazepines highlights the importance of implementing a thoughtful transition plan when executing such a national policy.

    Keywords: Medicare Part D, prescription drug coverage, elderly, Medicaid, Dual Eligibles

    Go to:

    INTRODUCTION

    Passage of the Medicare Part D drug benefit aimed to increase access to prescription drugs for America’s seniors without coverage. However, Part D affected more than just those seniors who were previously inadequately insured. Many seniors who were dually eligible for Medicaid and Medicare (Dual Eligibles) experienced a change from state-run programs to a program developed by the federal government, funded jointly by federal and state governments, and administered by private plans. Approximately 6.6 million dually eligible seniors were automatically enrolled in a Medicare Part D prescription drug plan on January 1st, 2006.1 Little is known about how these Dual Eligibles were affected by this change in coverage.

    Dual Eligibles had the opportunity to select the Part D plan of their choice prior to Jan. 1, 2006; those who did not enroll on their own were enrolled automatically in Part D to minimize gaps in coverage and to guarantee that low income patients were enrolled in a plan with a low income subsidy. Patients who were automatically enrolled were placed in plans with fully subsidized premiums, and medication copayments were subsidized for patients who reached the Part D coverage gap (the donut hole).2 Patients who were not satisfied with the plan automatically selected for them had the opportunity to switch to another low income subsidy plan.3

    Despite efforts to simplify the transition to Part D, many researchers and policy experts expressed concern about how Dual Eligibles fared during their transition in coverage.4–6 Prior to the transition to Part D, many Medicaid beneficiaries experienced very generous drug coverage with few formulary restrictions.7 After the transition, the overwhelming majority of these patients found themselves enrolled in tiered pharmacy benefit plans that required differential copayments for some drugs and placed new administrative barriers (e.g. prior authorization) to influence the use of others.8 These changes led some Dual Eligibles to pay more for the same medications they were previously taking, and other Dual Eligibles may have been required to switch to specific medications that were preferred by the individual prescription drug plans.9 To assist with these changes in coverage, more than half of states required plans to relax formulary restrictions during the transition period in an effort to minimize medication discontinuation.4 Surveys of Dual Eligibles indicate that there was substantial confusion at the time of transition as they dealt with new and often more restrictive formularies.10, 11 However, little is known about whether the changes in coverage affected the use of essential medications or patients’ out-of-pocket spending.

    Source : www.ncbi.nlm.nih.gov

    Do you want to see answer or more ?
    James 5 month ago
    4

    Guys, does anyone know the answer?

    Click For Answer