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President's Proposed Prescription Plan

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PRESIDENTíS PROPOSED PRESCRIPTION DRUG BENEFIT

The Presidentís plan to modernize Medicare would include a new, voluntary Medicare drug benefit. Called Medicare Part D, it would offer all beneficiaries, for the first time, access to affordable, high-quality prescription drug coverage beginning in 2002. This benefit would cost the Federal government about $118 billion from 2000 to 2009. It would be fully offset, primarily through savings and efficiencies in Medicare and, to a small degree, from the surplus amount dedicated to Medicare.

  • Meaningful coverage. Beginning in 2002, beneficiaries would have the option of participating in the new Medicare Part D program. It would have:
    • No deductible -- coverage begins with the first prescription filled and
    • 50 percent coinsurance, with access to discounts negotiated by private pharmacy managers after the limit is reached.

    The benefit would be limited to $5,000 in costs ($2,500 in Medicare payments) in 2008. It would phase it a $2,000 for 2002-2003; $3,000 for 2004-2005; $4,000 for 2006-2007; and $5,000 in 2008 (indexed to inflation in subsequent years).

  • Affordable premiums. Beneficiaries who opt for Part D would a pay separate premium for Medicare Part D -- an estimated $24 per month in 2002, and $44 per month in 2008 when fully implemented. This premium represents 50 percent of program costs. Enrollment would be optional and, after an initial open enrollment for all beneficiaries in 2001, would occur when a beneficiary becomes eligible for the program or when they transition out of employer-based coverage. Premiums would generally be deducted from Social Security checks.
    • Low-income protections. Beneficiaries with income up to 150 percent of poverty ($17,000 for a couple) would pay no Part D premium. Those with income below 135 percent of poverty ($15,000 for couples) would pay no premiums or cost sharing. This assistance would be administered through Medicaid, with the Federal government assuming all of the premium and cost sharing costs for beneficiaries with incomes above poverty.

  • Private management. Beneficiaries in managed care plans would continue to receive their benefit through their plan. For enrollees in the traditional program, Medicare would contract with numerous private pharmacy benefit managers (PBMs) or similar entities. Medicare would use competitive bidding to award contracts for drug management. The private managers would use the latest, effective cost containment tools, drug utilization review programs, and meet quality and consumer access standards. No price controls would be imposed.
  • Incentives to develop and retain retiree coverage. Employers that choose to offer or continue retiree drug coverage would be provided a financial incentive to do so.


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Table of Contents

The Facts About Medicare Slide Show

Coverage for Medicare Beneficiaries

Overview

Importance of Prescription Drugs

Prescription Drug Spending

Proposed Plan

Appendix