PCMA: Part D Plans and PBMs Continue to Deliver Savings in Medicare

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Pharmaceutical Care Management Association

Aug 04, 2011, 03:26 ET

'A Rare Federal Program That Comes in Under Budget Each Year'

WASHINGTON, Aug. 4, 2011 /PRNewswire-USNewswire/ -- According to new data released by the Centers for Medicare & Medicaid Services (CMS), the 2012 average Medicare Part D prescription drug plan premium is roughly $30, a figure far lower than the $41 figure that was originally estimated in 2003. The premium figure confirms the success of Medicare Part D plans in delivering savings, said the Pharmaceutical Care Management Association (PCMA) today.

"With the help of pharmacy benefit managers, Part D sponsors continue to exceed expectations in terms of savings, choice, and satisfaction in Medicare," said PCMA President and CEO Mark Merritt. "Part D is a rarity among federal programs in that it actually comes in under budget each year."

This latest data comes on the heels of two new reports that highlight the success of Part D:

Government Accountability Office (GAO) report that found "90 percent of the mid-year changes plans make to formularies are enhancements like covering a new drug. In the few cases when a drug is no longer covered, it's usually because a generic version of that drug has become available."

Journal of the American Medical Association study that found "implementation of Medicare Part D was followed by a significant reductions in nondrug medical spending, particularly on acute and post acute care, for elderly Medicare beneficiaries with limited prior drug coverage." This study is a potential "game-changer" and shows how better prescription drug benefits can generate significant savings in other health care settings. Many illnesses, hospitalizations, and emergency room visits occur because seniors with sub-par benefits didn't have access to the medications they needed. The Part D example shows that more competition and greater use of PBM tools like home delivery of chronic refills can help address this issue.

PCMA represents the nation's pharmacy benefit managers (PBMs), which improve affordability and quality of care through the use of electronic prescribing (e-prescribing), generic alternatives, mail-service pharmacies, and other innovative tools for 200-plus million Americans.

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SOURCE Pharmaceutical Care Management Association