Today, as a deeper dive into how Extra Help works, we’re sharing Diane’s story. Diane is a hypothetical Medicare patient benefitting from the Extra Help Program.
Medicare Part D: A Success Story
Patients who don’t fit the average may have difficulty gaining access to the treatment best for them.
For osteoporosis, a disease that affects millions of Americans, there are currently nine medicines in clinical trials or undergoing review by the U.S. Food and Drug Administration.
ASP is a market-based price that reflects the weighted average of all manufacturer sales prices and includes all rebates and discounts that are privately negotiated.
Benefit to Patients
By increasing access to needed medicines, Part D helps improve beneficiaries’ overall health and reduce the use of other costly and avoidable health care services, such as hospitalizations. For example, Part D coverage was linked to an 8 percent decrease in hospital admissions for seniors, according to a 2014 National Bureau of Economic Research study. Gaining Part D coverage also improved adherence among enrollees with congestive heart failure, which led to over $2.3 billion in annual savings to Medicare, driven by reductions in Parts A and B expenditures. Additionally, Medicare beneficiaries have enjoyed relatively stable average monthly Part D premiums (just $32 in 2015 – up just $1 from 2014), which helps keeps coverage affordable.
Success of the Program
Part D has succeeded beyond expectations, delivering needed prescription medicines at a far lower cost than anticipated due to rigorous competition in the program. According to figures from the Congressional Budget Office (CBO), total program costs are $349 billion (or 45 percent) less than initial 2004-2013 projections. And in 2014, Part D represented just 10.9 percent of total Medicare spending. Another testament to the program's success: about 90 percent or more of beneficiaries are satisfied with the program (source: MedPAC, Medicare Today).
Competition and Choice
The Part D program is unique in that private plans submit competitive bids each year to determine the cost of the benefit, rather than government-set pricing. Private Part D plans compete to deliver affordable coverage for beneficiaries while also providing value for taxpayers. Medicare Part D plans also negotiate significant discounts and rebates with drug manufacturers to achieve savings on medicines, and use them to help reduce premiums, deductibles and cost-sharing for beneficiaries. With a wide range of available plans – more than 1,000 plans available nationwide, with an average of 24 plans to choose from in every region in 2015 – beneficiaries can choose a plan that best meets their individual coverage and financial needs and, in turn, they are better able to adhere to prescribed treatment regimens.