Medicare Blog: Moorestown, Cranford NJ

HR3 - the Lower drug costs now act

10/25/2019

Nancy Pelosi recently introduced a bill to lower the cost of drugs in the United States.

There are several key section to this bill.

Ends the ban on Medicare negotiating directly with the drug companies, and creates powerful new tools to force drug companies to the table to agree to real price reductions, while ensuring seniors never lose access to the prescriptions they need.
Makes the lower drug prices negotiated by Medicare available to all Americans, including those with private insurance, not just Medicare beneficiaries.
Stops drug companies ripping off Americans while charging other countries less for the same drugs, limiting the maximum price for any negotiated drug to the average price in countries like ours, where drug companies charge less for the same drugs – and admit they still make a profit.
Creates a new, $2,000 out-of-pocket limit on prescription drug costs for Medicare beneficiaries, and reverses years of unfair price hikes above inflation across more than 8,000 drugs in Medicare.
Reinvests in innovation and the search for new cures and treatments, using some of the savings from lowering the unjustified drug prices that are bankrolling Big Pharma’s stock-buybacks to reinvest billions of dollars in the search for new breakthrough treatments and cures at NIH.

The $2,000 out of pocket limit would be great for Medicare Beneficiaries since there is currently No out of Pocket Maximum. However, we do have some concerns with the proposed solution which would put most of the financial burden on the Part D Plans. The concern is that the Part D Plans will need to increase Part D Premiums to offset the increased financial burden above the $2,000 maximum. Currently about 4% of Medicare Beneficiaries reach the Catastrophic Phase of Part D. This $2,000 cap on Part D would definitely help those individuals, but the concern is that the other 96% of beneficiaries would see significant premium increases to their Part D Plans to offset this new Cap. Conceptually we are fully supportive of reducing drug costs and a cap on Part D would be great, but we believe it should be more of a shared burden with the Government so it doesn't negatively impact the other 96% of Medicare Beneficiaries.

This bill will likely go to a Vote in the House in the next 1-3 weeks.

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Medicare Plan Finder - justin continues to work with CMS

10/18/2019

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Since the government released the new Medicare Plan Finder on August 27, our frustration and stress level has been very high.

As a member of the Medicare Advisory Group of National Association of Health Underwriters, I was given an opportunity to have twice weekly calls with the CMS Requirements & Technical teams to discuss a list of key open items with the new Medicare Plan Finder.

In the last couple of weeks there have been significant improvements to the new Medicare Plan Finder including the addition of the Total Cost Calculator & Sort, and the fix for Mail Order Pricing Costs as well.

Click here to listen to the NAHU Happy Hour Podcast where I joined as a Special Guest discussing the ongoing process working with CMS.

I will continue to work with CMS to review key open items for resolution.

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Medicare Plan Finder - Total Cost Added!

10/11/2019

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When the new Medicare Plan Finder was launched on August 27, 2019 we had several concerns with missing functionality.

Our biggest concern was the fact that the new Medicare Plan Finder tool did not include the Total Cost Calculator and Sort function (Premium + Drug Cost). The function allows a user to quickly understand the Total Projected annual cost for each of the ~30 different Part D Plans available in each state, and thus enroll in the most cost-effective option.

On October 10, 2019 the Total Cost Calculator and Sort was added to the new Medicare Plan Finder. This is a significant milestone which allows us to complete the Part D Plan Analysis for our clients.

Below is a short video that shows how to use the new Medicare Plan Finder.

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SILVERSCRIPT CHOICE Part d plan - annual notice of Change (ANOC) - NJ

9/18/2019

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As you may have read from our prior Blog posts and videos, the government has released a new Medicare Plan Finder tool for 2020 and will be shutting down the existing Medicare Plan Finder tool, which limits our ability to review Part D Drug Plans for 2020.

So, we wanted to send out a couple of examples of ANOCs (Annual Notice of Changes) for two of the more popular Part D Plans in NJ.

This ANOC above is for SilverScript Choice and the ANOC explains what is changing in 2020.

Monthly Premium: reducing $0.30 from $35.20 to $34.90
Deductible (tier 3-5): increasing $305 from $0 to $305
Tier 1 copay at Preferred Pharmacy: reduced $3 from $3 to $0

Tier 1 copay at Standard Pharmacy: reducing $2 from $7 to $5
Tier 2 copay at Preferred Pharmacy: reducing $13 from $14 to $1
Tier 2 copay at Standard Pharmacy: reducing $14 from $20 to $6

Tier 3 copay at Preferred Pharmacy: increasing $4 from $43 to $47
Tier 4 cost sharing at Preferred Pharmacy: reducing from 47% to 38%
Tier 4 cost sharing at Standard Pharmacy: reducing from 50% to 38%
Tier 5 cost sharing at Preferred Pharmacy: reducing from 33% to 27%
Tier 5 cost sharing at Standard Pharmacy: reducing from 33% to 27%

Bottom line, SilverScript Choice used to be the lowest premium plan with a $0 deductible. This year they introduced a deductible of $305 for higher tiered medications, but they did lower the cost sharing for basically every Tier of medication for 2020.

The 2020 Formulary has not been published yet but we recommend checking to make sure your drugs remain on the formulary for 2020.

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wellcare value script part d plan 2020 Annual notice of change

9/18/2019

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As you may have read from our prior Blog posts and videos, the government has released a new Medicare Plan Finder tool for 2020 and will be shutting down the existing Medicare Plan Finder tool, which limits our ability to review Part D Drug Plans for 2020.

So, we wanted to send out a couple of examples of ANOCs (Annual Notice of Changes) for two of the more popular Part D Plans in NJ.

This ANOC above is for WellCare Value Script and the ANOC explains what is changing in 2020.

Monthly Premium: increasing $3.80 from $11.90 to $15.70
Deductible (tier 3-5): increasing $20 from $415 to $435
Tier 1 copay at Preferred Pharmacy: remains at $0

Tier 1 copay at Standard Pharmacy: increasing $2 from $3 to $5
Tier 2 copay at Preferred Pharmacy: increasing $1 from $5 to $6
Tier 2 copay at Standard Pharmacy: increasing $3 from $8 to $11

Tier 3 copay at Preferred Pharmacy: increasing from $41 to $43
Tier 4 cost sharing at Preferred Pharmacy: increasing from 48% to 49%

Bottom line, if you have low cost Tier 1 generic medications this is probably still the best Plan for you in 2020. The 2020 Formulary has not been published yet so we can't confirm for sure, but hopefully this will become available in the next few weeks.

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Boston globe article with help from Justin

9/11/2019

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In the beginning of October, we will have an opportunity to review your Prescription Drug Plan for 2020. There are about 30 different Part D Plans to choose from, Medicare Part D coverage changes every year, and the Prescription plans change every year.

This year, we have some new challenges.

The Boston Globe released an article yesterday (with our help), which outlined some of these challenges.

Also, over the last few weeks, we have sent out a few communications related to new Medicare Plan Finder tool.

There are some significant gaps with the new Medicare Plan Finder. Most notably,
(1) the Total Estimated Cost Calculation (Premium + Drug Costs) is not available,and
(2) there is no ability to save the drug list information using the anonymous flow.

For issue #1, CMS has indicated this functionality will be added to the Medicare Plan Finder Tool by Annual Enrollment. This is absolutely critical for Senior Advisors to be able to determine the most cost effective Part D Plan. We don't want to hold up the Rx information forms any longer waiting for this fix, so we are sending out the Reminder emails so you can start to complete your Rx information. Please note, If CMS does not fix this issue by October, we will not be able to complete the Part D Plan Comparisons for 2020.

For issue #2, in order to review and save Drug Lists and comparisons, we are going to need to create/use your myMedicare.gov account credentials (username/password). On our Rx Information Form, you will see additional fields and a question to authorize Senior Advisors to create your myMedicare.gov account or use your existing account if you already created one.

If you would like us to complete the FREE Part D Analysis, you can complete our Rx information form.

Please be sure to select Plan Year "2020" for Annual Enrollment.

Here is a link to a short video that explains the new Rx information form.
If your drug list hasn't changed, we still need you to complete the online form so we can ensure we have the correct drug information for the Part D Analysis.

If you are not taking any medications, please quickly fill out the online form and answer "No" the question "Do you currently take any medications?"

The deadline to submit your form to us is November 15, but please do not wait until the last minute if you are able to submit sooner.

We have extended our processing time expectations this year due to the issues with the New Medicare Plan Finder tool and the unknown issues we expect to encounter with a brand new tool.

Our target turn-around times are below.

RX Forms submitted before October 8 - since the Part D drug plans for 2019 are not released until the first week of October, we will not be able to review your 2019 Part D Analysis until October. So, if you submit your RX information form prior to October 8, you should still receive an automatic email acknowledgement and then you will receive a Part D recommendation from us by October 31.
RX Forms submitted between October 8 and November 15- If you submit your RX information form between October 8 and November 15, you should receive a response / recommendation from us within 14-21 business days.

Do not submit your RX Forms after November 15 - we will not be able to guarantee that we will be able to review the Part D analysis and make a recommendation in time to make the December 7 deadline.

We look forward to enrolling you in the right 2020 Part D Plan for your specific situation.

Thank you for your continued business. We appreciate the opportunity to serve you.

CLICK HERE TO GET YOUR FREE PART D ANALYSIS

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2020 Part D Changes

9/10/2019

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Medicare Part D Changes Annually

Each year, Medicare changes the benefits provided under Medicare Part D. These changes could impact your annual costs for your Prescription Drug Coverage. Specifically in 2020 here are some key changes for Medicare Part D.

Initial Deductible: will be increased by $20 from $415 in 2019 to $435 in 2020. What does this mean for you? The initial deductible is the ‘first dollar’ spent on your prescriptions. Certain plans will have a $435 deductible, which means that the individual will have to pay their first $435 in drug costs before the benefits start, but this usually only applies to higher tiered medications. Other plans may offer a $0 deductible, which means that the benefits start immediately.
Initial Coverage Limit: will increase $200 from $3,820 in 2019 to $4,020 in 2020. What does this mean for you? The initial coverage limit protects individuals from the dreaded “Donut Hole” (aka Coverage Gap), which results in higher out-of-pocket costs. After the total retail drug cost exceeds the initial coverage limit, the individual will fall into the Donut hole. By increasing the initial coverage limit by $200, this is a minor improvement which lowers the probability of reaching (or delays the timing to reach) the donut hole , which is a good thing.
True Out-of-Pocket (TrOOP) Threshold: will increase from $5,100 in 2019 to $6,350 in 2020. What does this mean for you? In most cases, this won’t have an impact. Less than 5% of people actually reach this threshold. Catastrophic coverage benefits start when someone exceeds the Out-of-Pocket threshold. In Catastrophic coverage, individuals will pay a much lower fee for their drugs – either 5% of the drug cost or a specific co-pay amount, whichever is greater.

Generic Copay in Catastrophic Coverage– increasing from $3.40 in 2019 to $3.60 in 2020
Brand Name Copay in Catastrophic Coverage – increasing from $8.50 in 2019 to $8.95 in 2020

By increasing the Out-Pocket threshold by $1,250, this could have a significant impact (several hundred dollars) on those individuals that previously reached the Catastrophic Coverage level.

All of these Medicare Part D changes in 2020 will have an impact on selecting the right Part D Prescription Plan for 2020.

Prescription Plan Part D Changes Annually
In addition to the Medicare Part D changes, the insurance companies change their Prescription drug plans each year. These changes could impact the formulary (which drugs are covered), deductibles, premiums, etc.

It is imperative to select the right plan EACH YEAR to avoid the type of mistakes which could result in thousands of dollars of unnecessary costs!

There are about 25 Medicare Part D Prescription plan options in each state, and we strongly recommend using the tools on medicare.gov and/or contacting a trusted insurance broker to assist in this process.

A FREE Service offered to our clients…
We feel very strongly about ensuring our clients have the correct Part D Prescription Drug Card and thus, we provide the option for all of our clients to have their Prescription Drug coverage reviewed annually.

Click Here to Find out more about our FREE RX Analysis program.

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New Medicare Plan Finder Released 8/27/19

8/28/2019

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On Friday, August 16, 2019 we attended a webinar with CMS which provided a quick demo of the New Medicare Plan Finder (MPF) tool that is launching this year. We had some concerns after the demo regarding some lost functionality in the new tool.

Yesterday, Tuesday August 27, 2019, CMS launched the new Medicare Plan Finder tool and our initial review raised additional concerns for this upcoming Annual Enrollment Period (Oct 15 - Dec 7). In the full video (23 minutes), you will see a side-by-side comparison with the New MPF (left tab) and the Old MPF (right tab).

If you would prefer to skip to the highest Severity issues, you will find the list below with the timestamp of the video in which the issue is reviewed.

Issue #1 (11:40 into the video)
New MPF doesn't Calculate/Sort Total Overall Expense (Premium + Drug Costs).
The main reason we use the Old Medicare Plan Finder is to identify the most cost effective Part D Plan for our clients (when they initially enroll in Medicare Part D) and during Annual Enrollment Period each year (Oct 15 - Dec 7).

Below is a sample screenshot of the Old MPF Plan Results page which shows the Total Cost as of Today (Premium + Drugs) and sorts the list accordingly...

After entering in the zip code, drug information, and pharmacy, the Old MPF quickly calculates the TOTAL overall expense (Premium + Drugs) for all ~30 Part D Plans available in the area and then automatically sorts the list based on the lowest overall expense. This calculation and sorting of ~30 Part D Plans is Invaluable. We would not have the time to go through ~30 different Part D Plans to manually calculate the total projected expense and find the lowest overall number for thousands of clients in the short window of Oct 15 - Dec 7.

Last year during Annual Enrollment, this functionality allowed us to save our Medicare clients $2 Million + in Part D costs alone!

The New MPF does not have this functionality to calculate the Total Overall Expense (Premium + Drugs) and sort the Plans accordingly. Thus, we will not be able to efficiently find the most cost-effective Part D Plans for our clients with the New MPF in it's current state.

Issue #2 (9:50 into the video)
New MPF doesn't have the ability to save Drug List ID.
As mentioned, we review thousands of Part D Plans each year during the Annual Enrollment. One of the nice benefits of the Old MPF is something called a "Drug List ID" which allows us to store an identifier for a particular Drug List, so we don't have to re-enter every single medication each time we rerun the drug analysis.

The New MPF doesn't have this Drug List ID or any functionality to save a Drug List that was used for a Part D analysis.

(The new MPF will have functionality to pull Rx claims data for authenticated Beneficiaries with a username & Password, so this could help with some of the Rx entries, but the new MPF still doesn't allow us to save the Drug List that is being used for the Analysis.)

Issue #3 (16:25 into the video)
Report functionality is very limited with the new MPF.
One of the other great benefits of the Old MPF is the ability to create a clean and comprehensive report which outlines all of the details of the Part D Plans being compared. The information in these reports provides everything we need to know about a Part D Plan including:

Premium,
Deductible
Total Projected Overall Expense for the Year
Projected Drug Costs for each of the Drugs at each of the Pharmacies entered
If you will reach the Donut Hole (and when),
If you will reach Catastrophic Coverage (and when)
Drug Tiers for the Medications being taken, Prior Authorization or Step Therapy Required for each medication
Projected costs by month including Tables & Charts
And more!

Below is a link to a short video that provides an overview of the Reports that are available in the Old MPF.

In the New MPF, there is very limited Reporting capability which is highlighted starting at the 16:25 mark of the video review mentioned above.

We will continue to provide our feedback to CMS to hopefully get these concerns addressed.

Also, there will be impacts to our online Rx information form and Email Reminders to all of our clients for their latest Rx information. We won't know the full impacts (and be able to implement the changes) until we see the updates/fixes to the MPF over the next few weeks.

We will keep you posted as we get more updates.

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New Medicare Plan Finder Launching Soon!

8/22/2019

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On Friday, August 16, 2019 I attended the CMS (Centers for Medicare & Medicaid Services) Webinar*, which provided an overview of new MPF tool which will be launching “before Labor Day 2019”.

Please note that all of my feedback below is based on a very brief 30-minute demo (and 30 min Q&A) that was provided by CMS.

My initial reaction is that the intentions are good, but a system overhaul of this magnitude should never be launched this close to the highest volume period of activity (i.e. Annual Enrollment) for a system.

There are some major changes in the new tool, which will significantly impact Medicare Beneficiaries and agents that use the Medicare Plan Finder tool.

I will do my best to highlight some of the positives first…

Some of the Positives:

Authenticated Medicare Plan Finder – the new Medicare Plan Finder will allow for an Anonymous search (like the Current MPF), however there will also be a new type of Search that allows for an Authenticated login. If a user creates an account and logs in, the tool will be able to query the last 12 months of Rx Claims Data for that individual. This could be helpful to pull a drug list for an existing Medicare Beneficiary.
Part B Drug Costs Available in the new Medicare Plan Finder Tool – in the current MPF tool, Part B drug costs are not available. These Part B drugs can be some of the most expensive drugs so it’s difficult to project costs for individuals that will be taking these medications. In the new tool, Part B drug costs will be available if you use the Medicare Advantage Search Path (since most Plans require Beneficiaries to pay 20% of Part B drug costs).
3 Pharmacies instead of 2 Pharmacies – the current MPF tool only allows the user to search for costs based 2 Pharmacies. The new tool will allow a third pharmacy to be added to the Cost Comparison.
Drug List max of 40 drugs (instead of 25) – the current tool limits the number of medications that can be entered to 25. The new tool will increase that limit to 40 medications.
New “Look & Feel” – the new tool has a new “look and feel” that is intended to improve navigation and clarity.

Some Concerns:

The Existing Tool will not be available for this AEP – as mentioned earlier, a change of this magnitude should either be run in parallel with the existing system OR it should be deployed in an off-season, rather than the busiest time of the year for the MPF.
Drug List ID No Longer Available – The existing system has a Drug List ID, which allows a Medicare Beneficiary to pull up the list of Drugs that was used on a prior Plan Search so they don’t have to re-enter all the same Drug Info again, and again, and again…and again… each time they want to shop for a Plan. The New Tool will no longer have this functionality. Thus, when someone is using the tool to shop for a Plan for the first time, they will have to re-enter their Rx information every time they want to go back in and shop the Plans again. For one or two medications, this isn’t a big deal. However, if a Beneficiary has a long list of medications this can be incredibly cumbersome. For Agents that have to do hundreds or even thousands of these Rx reviews in just a few short months, these extra steps can be extremely detrimental to being able to recommend the best Plans possible for Medicare Beneficiaries.
Creating PDF summary reports – functionality available? The Existing MPF tool allows a user to create a very detailed and comprehensive report which outlines Drug Costs by month, at different pharmacies, timing for reaching the Doughnut Hole, Catastrophic Coverage, etc. These reports are invaluable for providing a clear outline of cost projections to Medicare Beneficiaries. During the Webinar, we were not shown this report functionality, so it is not clear whether the new tool will allow for this level of reporting. If this reporting is not available, this would create major communication and expectation issues with Medicare Beneficiaries.

At Senior Advisors, we still plan to provide the FREE Annual Review of Part D coverage for all of our clients as we have in the past. However, this year will certainly be more challenging and we ask for your patience as we work through these reviews using a brand new tool for 2020 Plans.

* A recording of this webinar along with PowerPoint slides will be posted in the “Resources” tab of the NTP website at https://cmsnationaltrainingprogram.cms.gov/, as soon as the Plan Finder is publicly launched.

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GAO Study on Medicare Plan Finder

8/8/2019

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For Medicare Beneficiaries on Medicare Advantage Plans or Part D Prescription Plans, there is an opportunity each year to review and switch these Plans during the Annual Enrollment Period (October 15 - December 7).

The best tool available to analyze these options is the Medicare Plan Finder (MPF) on Medicare.gov. This tool allows us to search for the best Medicare Advantage Plans and Part D Prescription Plans for each individual based on their specific medications/needs.

I cannot overstate the importance of the MPF for finding the right plan. Without a tool like the MPF, there would be no efficient way to shop for the best Plan for each individual in each service area across the country. The tool allows someone to quickly compare over 20 different Part D Plan options and 10-30 different Medicare Advantage Plan options (depending on the service area).

Over the years, there have been some flaws with the system, but overall it is quite an effective tool for Agents to shop for these Medicare Plans.

Recently, the the Government Accountability Office (GAO) released a study which highlighted some usability issues with the MPF according to “stakeholders and research studies”.

What GAO Found
The Medicare Plan Finder (MPF) website—a primary resource for comparing Medicare coverage options—is difficult for beneficiaries to use and provides incomplete information, according to stakeholders and research studies. These sources and directors of State Health Insurance Assistance Programs (SHIP) GAO surveyed—who assist beneficiaries with their Medicare coverage choices—reported that beneficiaries struggle with using MPF because it can be difficult to find information on the website and the information can be hard to understand. For example, MPF

requires navigation through multiple pages before displaying plan details,
lacks prominent instructions to help beneficiaries find information, and
contains complex terms that make it difficult for beneficiaries to understand information.

In response to GAO's survey, 73 percent of SHIP directors reported that beneficiaries experience difficulty finding information in MPF, while 18 percent reported that SHIP counselors experience difficulty.

My perspective is slightly different. I think the MPF does a great job of providing a quick comparison of coverage options for Medicare Beneficiaries. Sure, it’s not perfect (and there are even times when the data is off, which is a problem), but overall I think the MPF tool is incredibly valuable.

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