PDPs for Low-Income Beneficiaries Decreasing in ’09--October 2008


A Washington, DC–based research firm finds that low-income beneficiaries will have fewer drug plan options next year.

Wisconsin is the only state where low-income beneficiaries in Medicare’s prescription drug program will not have fewer plans to choose from in 2009, according to independent analysis by Avalere Health.

The analysis revealed that, nationwide, there will be a total of 308 prescription drug plans (PDPs) qualified to serve low-income beneficiaries in 2009, nearly 200 fewer than in 2008. These almost 200 plans covered approximately 1.3 million individuals who will now need to be reassigned, raising concerns among advocates that millions will be forced to change plans and may not find the same type of coverage. The new estimate is up from 1.2 million in 2008 and 250,000 in 2007.

Using its proprietary DataFrame database, Avalere researchers compared 2008 and 2009 standalone PDPs qualified to serve low-income beneficiaries, including dual eligibles in all 50 states. Six states—Arizona, Florida, Hawaii, Nevada, Maine, and New Hampshire—will each have 5 or fewer PDPs available to automatically enroll low-income residents next year. Nevada will have only one autoenrollment PDP, thus leaving low-income residents in that state with no PDP choices, unless they move to a Medicare Advantage plan. Arizona follows with only 2 options available. Wisconsin will have 16 autoenrollment PDPs, unchanged from 2008 and higher than any other state.

One large insurer, Humana, continued its withdrawal from the low-income market this year and will not have any eligible low-income plans next year. United Healthcare, however, expanded its presence in the market after losing nearly 600,000 low-income beneficiaries last year. Of the top 10 PDPs as ranked by August 2008 enrollment, only one—United Healthcare’s AARP MedicareRx Saver—will see an increase in the number of low-income coverage.

For other articles in this issue, see:

Kids’ OTC Cough, Cold Meds to Get New Labels

Survey Finds Patients Wary of Rx Switches

Rogue Pharmacy Crackdown Expected to Become Law

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