The Affordable Care Act – A Stronger Medicare Program in 2012
This second annual report details how millions of
seniors and people with disabilities with Medicare continued to
experience lower costs on prescription drugs and improved benefits in
2012 because of the Affordable Care Act.
Since the law’s enactment, 6.1 million Americans with Medicare who reached the Part D coverage gap, also known as the “donut hole,” have saved
more than $5.7 billion on
prescription drugs. Drug savings of $2.5 billion in 2012 are higher
than the $2.3 billion in savings for 2011. In 2012, people with
Medicare in the “donut hole” received a 50-percent
discount on covered brand-name drugs and 14-percent discount on generic drugs. As a result of the Affordable Care Act, coverage for both brand-name and
generic drugs will continue to increase over time until the coverage gap is closed.
The Affordable Care Act also removed barriers for
people with Medicare to get preventive services, many of which
previously required cost-sharing for patients. In 2012, many
recommended preventive services were offered to people with Medicare,
with no deductibles or co-pays, meaning that cost is no longer a
barrier for seniors and people with disabilities who want to stay
healthy by detecting and treating health problems early. Use of
preventive services has expanded among people with Medicare.
In 2012 alone, an estimated 34.1 million people with Medicare benefited
from Medicare’s coverage of preventive services with no cost-sharing.
Under the Affordable Care Act, the Medicare program also performed well in several other areas in 2012:
• Compared to 2011, people with
Medicare continued to pay moderate premiums for Medicare Part B
benefits, which cover outpatient care, doctors' services, lab tests,
durable medical supplies, and other services.
• Those who enrolled in Medicare
Advantage and prescription drug plans paid average premiums lower than
what they paid in 2010, and they had access to a wide range of plan
choices.
• New techniques were implemented to detect, prevent and fight health care fraud.
NEW DATA SHOWS THAT SINCE AFFORDABLE CARE ACT ENACTMENT,
MORE THAN 6.1 MILLION MEDICARE BENEFICIARES HAVE SAVED
MORE THAN $5.7 BILLON ON PRESCRIPTION DRUGS
The Affordable Care Act makes prescription drug
coverage (Part D) for people with Medicare more affordable. It does this
by gradually closing the gap in drug coverage known as the "donut
hole." For many people enrolled in Medicare Part
D, the “donut hole” occurs after they and their plan spend a certain
amount of money for covered drugs, but before they hit catastrophic
coverage in which they are only responsible for a small percent of their
drug costs. Prior to the Affordable Care Act,
an individual in the “donut hole” had to pay the full costs of
prescription drugs.
The Affordable Care Act is closing the “donut hole” over time, by first providing a one-time
$250 check for those that reached the “donut hole” in 2010, then by
providing discounts on brand-name drugs
for those in the “donut hole” beginning in 2011, and additional savings
each year until the coverage gap is closed in 2020. People with
Medicare in the “donut hole” receive the discounts when they purchase
prescription drugs at a pharmacy or order them through
the mail, until they reach the catastrophic coverage phase. Since its
enactment in 2010, the law has saved
more than 6.1 million seniors and people with disabilities more than $5.7 billion on brand-name prescription drugs.
The HHS Assistant Secretary for Planning and
Evaluation projected average savings per Medicare beneficiary to be
approximately $5,000 from enactment through 2022, while those with high
prescription drug spending are projected to save much
more – over $18,000. These projections, in addition to prescription
drug plan data on 2012 spending, demonstrate that those with high drug
costs are seeing considerable savings thanks to the Affordable Care Act.
In 2012, more than 3.5 million seniors and people
with disabilities who reached the Medicare Part D coverage gap received
discounts on brand- name prescription drugs. These individuals with
Medicare received more than $2.5 billion in discounts,
or an average of $706 per beneficiary. Savings for covered generic
drugs while in the “donut hole” in 2012 totaled $105 million for 2.8
million beneficiaries.
In 2012, coverage gap discounts allowed seniors and
people with disabilities to save money on a wide variety of drugs,
including:
• Blood Sugar Lowering Drugs: $435,794,413
• Asthma and Other Lung Related (non-cancer) Disease Drugs: $297,234,514
• Triglyceride and Cholesterol Lowering Drugs: $240,495,663
• Drugs Used to Lower Blood Pressure: $138,497,053
• Anti-dementia Drugs: $120,878,582
• Drugs Used to Treat Ulcers: $101,888,578
• Cancer Drugs: $97,263,505
• Anti-depression Drugs: $85,047,907
• Autoimmune Disease Anti-inflammatory Drugs: $56,715,485
• Psychiatric Drugs: $56,295,844
• All Other Drug Therapeutic Uses: $872,688,178
Most of the savings are on drugs for chronic
conditions, suggesting that people with Medicare who must continuously
take medications are benefitting most from the help provided by the
Affordable Care Act. Drugs managing chronic conditions
such as high blood sugar, high blood pressure and high cholesterol
accounted for almost 33 percent of savings and may have helped patients
avoid hospitalization. About 11 percent of the savings were for drugs
treating mental illness, which were designed to
help people with Medicare maintain healthy and active lives.
In 2013, people with Medicare in the coverage gap
are saving 52.5 percent on brand‐names drugs and 21 percent on generics.
These savings will increase each year until the coverage gap is closed
in 2020.
The schedule below illustrates how the coverage gap
will be closed, with information on drug savings for those in the
coverage gap.
Percentage Medicare Part D Enrollees will Save
|
||
Brand‐names Drugs
|
Generic Drugs
|
|
2014
|
52.5 percent
|
28 percent
|
2015
|
55 percent
|
35 percent
|
2016
|
55 percent
|
42 percent
|
2017
|
60 percent
|
49 percent
|
2018
|
65 percent
|
56 percent
|
2019
|
70 percent
|
63 percent
|
2020
|
75 percent
|
75 percent
|
STATE‐BY‐STATE SAVINGS FROM DISCOUNTS WHILE IN “DONUT HOLE”
Overall
|
2011
|
2012
|
||||
Total Savings
|
Total Gap Discount Amount
|
Total Gap Discount Amount
|
Total Number of Beneficiaries
|
Average Discount per Beneficiary
|
||
Nation
|
$5,760,182,946
|
$2,311,220,975
|
$2,502,799,722
|
3,547,246
|
$706
|
|
Alabama
|
$77,248,493
|
$31,807,551
|
$31,020,512
|
48,264
|
$643
|
|
Alaska
|
$4,059,730
|
$1,685,133
|
$ 1,794,910
|
2,278
|
$788
|
|
Arizona
|
$102,237,394
|
$39,489,954
|
$44,963,599
|
65,267
|
$689
|
|
Arkansas
|
$50,287,595
|
$21,076,421
|
$20,151,382
|
32,420
|
$622
|
|
California
|
$453,865,739
|
$182,381,722
|
$182,776,196
|
299,896
|
$609
|
|
Colorado
|
$59,645,855
|
$24,459,701
|
$24,339,969
|
37,733
|
$645
|
|
Connecticut
|
$78,759,336
|
$26,238,636
|
$41,932,782
|
47,677
|
$880
|
|
Delaware
|
$23,199,385
|
$10,010,926
|
$9,945,279
|
12,134
|
$820
|
|
District Of Columbia
|
$3,877,623
|
$1,638,772
|
$1,554,101
|
2,319
|
$670
|
|
Florida
|
$378,403,475
|
$152,489,277
|
$160,882,589
|
237,344
|
$678
|
|
Georgia
|
$161,956,926
|
$62,484,234
|
$72,511,462
|
99,057
|
$732
|
|
Guam
|
$396,918
|
$193,400
|
$151,268
|
242
|
$625
|
|
Hawaii
|
$20,299,348
|
$7,266,854
|
$6,931,057
|
18,474
|
$375
|
|
Idaho
|
$22,498,985
|
$9,225,783
|
$9,076,120
|
14,584
|
$622
|
|
Illinois
|
$235,327,301
|
$101,529,128
|
$95,923,083
|
133,889
|
$716
|
|
Indiana
|
$144,142,629
|
$61,466,902
|
$60,251,646
|
85,784
|
$ 702
|
|
Iowa
|
$64,928,785
|
$27,600,109
|
$25,848,452
|
39,260
|
$ 658
|
|
Kansas
|
$59,331,172
|
$24,968,485
|
$24,040,920
|
36,383
|
$661
|
|
Kentucky
|
$111,548,906
|
$43,289,351
|
$50,916,143
|
72,391
|
$703
|
|
Louisiana
|
$88,538,619
|
$32,316,242
|
$42,280,622
|
60,016
|
$ 704
|
|
Maine
|
$16,777,237
|
$6,775,456
|
$6,738,800
|
11,413
|
$590
|
|
Maryland
|
$84,167,415
|
$32,760,447
|
$37,572,535
|
48,949
|
$768
|
|
Massachusetts
|
$96,478,961
|
$39,363,887
|
$39,401,173
|
59,062
|
$667
|
|
Michigan
|
$153,484,151
|
$51,330,931
|
$79,375,077
|
106,707
|
$744
|
|
Minnesota
|
$88,256,958
|
$36,587,311
|
$34,886,726
|
54,175
|
$644
|
|
Mississippi
|
$50,711,580
|
$21,440,317
|
$20,640,606
|
32,649
|
$632
|
|
Missouri
|
$119,340,191
|
$49,676,876
|
$48,850,222
|
75,201
|
||
No comments:
Post a Comment