2381_sejda-DYJ.pdf - Chapter 12 References GCRP 2014 citing...

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Unformatted text preview: Chapter 12 References GCRP 2014. citing Beck, P.S.A., G.P. Juday, C. Alix, V.A. Barber, S.E. Winslow, E.E. Sousa, P. Heiser, J.D. Herriges, and S.J. Goetz. 2011. Changes in Forest Productivity across Alaska Consistent with Biome Shift. Ecology Letters 14:373–379. doi: 10.1111/j.1461-0248.2011.01598.x. GCRP 2014. citing Bouchama, A., M. Dehbi, G. Mohamed, F. Matthies, M. Shoukri, and B. Menne. 2007. Prognostic Factors in Heat Wave Related Deaths: A Meta-analysis. Archives of Internal Medicine 167:2170–2176. doi:10.1001/archinte.167.20.ira70009. GCRP 2014. citing Brook, B.W., N.S. Sodhi, and C.J.A. Bradshaw. 2008. Synergies among Extinction Drivers under Global Change. Trends in Ecology & Evolution 23:453–460. doi:10.1016/j.tree.2008.03.011. GCRP 2014. citing Bulbena, A., L. Sperry, and J. Cunillera. 2006. Psychiatric Effects of Heat Waves. Psychiatric Services 57:1519–1519. doi:10.1176/appi.ps.57.10.1519. GCRP 2014. citing Burke, L., L. Reytar, M. Spalding, and A. Perry. 2011. Reefs at Risk Revisited. World Resources Institute. Last revised: February 2011. Available at: . (Accessed: April 3, 2018). GCRP 2014. citing Burkett, V. and M. Davidson. 2012. Coastal Impacts, Adaptation and Vulnerabilities: A Technical Input to the 2013 National Climate Assessment. Island Press. Washington D.C. Last revised: 2013. Available at: . GCRP 2014. citing Cambridge Systematics Inc. and Texas Transportation Institute. 2005. Traffic Congestion and Reliability: Trends and Advanced Strategies for Congestion Mitigation. U.S. Department of Transportation, Federal Highway Administration. GCRP 2014. citing Carrier, S.D., G.L. Bruland, L.J. Cox, and C.A. Lepczyk. 2012. The Perceptions of Coastal Resource Managers in Hawai‘i: The Current Situation and Outlook for the Future. Ocean & Coastal Management 69:291–298. doi:10.1016/j.ocecoaman.2012.07.028. GCRP 2014. citing CCSP. 2009. Coastal Sensitivity to Sea-Level Rise: A Focus on the Mid- Atlantic Region. A Report by the U.S. Climate Change Science Program and the Subcommittee on Global Change Research. U.S. Environmental Protection Agency. GCRP 2014. citing Centers for Disease Control. 2012. Rocky Mountain Spotted Fever. GCRP 2014. citing Centers for Disease Control. 2013. Interactive Lyme Disease Map. Last revised: 2013. Available at: . GCRP 2014. citing Chapin III, F.S., P.A. Matson, and P.M. Vitousek (Eds.). 2011. Principles of Terrestrial Ecosystem Ecology. 2nd edition. Springer Science+Business Media, LLC. Springer-Verlag, New York.). GCRP 2014. citing Chen, I.-C., J.K. Hill, R. Ohlemüller, D.B. Roy, and C.D. Thomas. 2011. Rapid Range Shifts of Species Associated with High Levels of Climate Warming. Science 333:1024–1026. GCRP 2014. citing Cheung, W.W.L., V.W.Y. Lam, J.L. Sarmiento, K. Kearney, R. Watson, and D. Pauly. 2009. Projecting Global Marine Biodiversity Impacts under Climate Change Scenarios. Fish and Fisheries 10:235–251. 12-34 FIGURE Updating... X-X FIGURE 14–1 Part D’s defined standard benefit before and after introduction of the manufacturers’ discount on brand-name drugs in the coverage gap $12,000 Individual enrollee’s gross drug spending Medicare reinsurance Plan liability Enrollee cost sharing Manufacturer discount $10,000 $8,000 Out-of-pocket threshold $6,000 $4,000 Coverage gap 50% 100% Initial coverage limit $2,000 Deductible $0 2006 Note: 2011 “Gross drug spending” refers to amounts paid at the pharmacy before rebates and discounts. The coverage-gap phase (between the initial coverge limit and out-ofpocket threshold) is depicted as it would apply to brand-name drugs for an enrollee who does not receive Part D’s low-income subsidy (LIS). Non-LIS enrollees’ cost sharing for generic drugs in the coverage gap was 100 percent in 2006 and 93 percent in 2011. Source: MedPAC depiction of Part D benefit structure as set by law. a sponsor offers a PDP with basic benefits in a region, it can also offer up to two “enhanced-alternative” PDPs that combine basic benefits with supplemental coverage. For 2019, estimated OOP costs between a sponsor’s Note: In InDesign. basic and enhanced plans must differ by at least $22 per month. CMS no longer requires plan sponsors to maintain a meaningful difference in OOP costs between two enhanced-alternative PDPs. Changes to Part D’s coverage gap The policymakers who designed Part D wanted to provide both basic coverage for most enrollees who have relatively low drug spending as well as some catastrophic protection for enrollees with high drug costs. For this reason, the defined standard basic benefit initially covers 75 percent of drug spending above the deductible and all but 5 percent coinsurance once an enrollee reaches the OOP threshold. That threshold is known as “true OOP” because it excludes cost sharing paid on behalf of a beneficiary by most sources of supplemental coverage, such as employersponsored policies and enhanced-alternative plan benefits. However, the policymakers who designed Part D also needed to keep program costs within an agreed-on spending target (Blum 2009). For this reason, before 2011, enrollees with spending that exceeded the initial coverage limit were responsible for paying a prescription’s full price at the pharmacy up to the OOP threshold. That is, the enrollee’s cost sharing rose from 25 percent in the initial coverage phase to 100 percent until he or she reached the OOP threshold (left-hand side of Figure 14-1). A number Report to the Congress: Medicare Payment Policy  |  March 2019 391 Chapter 12 References GCRP 2014. citing Chokshi, D.A. and T.A. Farley. 2012. The Cost-Effectiveness of Environmental Approaches to Disease Prevention. New England Journal of Medicine 367:295–297. GCRP 2014. citing Cross, M.S., P.D. McCarthy, G. Garfin, D. Gori, and C.A.F. Enquist, 2013: Accelerating Adaptation of Natural Resource Management to Address Climate. Conservation Biology. 27:4–13. GCRP 2014. citing Dawson, T.P., S.T. Jackson, J.I. House, I.C. Prentice, and G.M. Mace. 2011. Beyond Predictions: Biodiversity Conservation in a Changing Climate. Science 332:53–58. GCRP 2014. citing Degallier, N., C. Favier, C. Menkes, M. Lengaigne, W.M. Ramalho, R. Souza, J. Servain, and J.P. Boulanger. 2010. Toward an Early Warning System for Dengue Prevention: Modeling Climate Impact on Dengue Transmission. Climatic Change 98:581–592. GCRP 2014. citing Deisenhammer, E.A. 2003. Weather and Suicide: The Present State of Knowledge on the Association of Meteorological Factors with Suicidal Behaviour. Acta Psychiatrica Scandinavica 108(6):402–409. GCRP 2014. citing Diuk-Wasser, M.A., G. Vourc’h, P. Cislo, A.G. Hoen, F. Melton, S.A. Hamer, M. Rowland, R. Cortinas, G.J. Hickling, J.I. Tsao, A.G. Barbour, U. Kitron, J. Piesman, and D. Fish. 2010. Field and Climate-based Model for Predicting the Density of Host-seeking Nymphal Ixodes Scapularis, An Important Vector of Tick-borne Disease Agents in the Eastern United States. Global Ecology and Biogeography 19:504–514. GCRP 2014. citing Doney, S.C., W.M. Balch, V.J. Fabry, and R.A. Feely. 2009b. Ocean Acidification: A Critical Emerging Problem for the Ocean Sciences. Oceanography 22:16–25. GCRP 2014. citing Dudgeon, S.R., R.B. Aronson, J.F. Bruno, and W.F. Precht. 2010. Phase Shifts and Stable States on Coral Reefs. Marine Ecology Progress Series 413:201–216. GCRP 2014. citing Easterling, W.E. 2010. Guidelines for Adapting Agriculture to Climate Change. Handbook of Climate Change and Agroecosystems: Impacts, Adaptation, and Mitigation, ICP Series in Climate Change Impacts, Adaptation, and Mitigation – Vol. 1. Imperial College Press. 452 pp. GCRP 2014. citing Emberlin, J., M. Detandt, R. Gehrig, S. Jaeger, N. Nolard, and A. Rantio-Lehtimaki. 2002. Responses in the Start of Betula (birch) Pollen Seasons to Recent Changes in Spring Temperatures Across Europe. International Journal of Biometeorology 46:159–170. GCRP 2014. citing EPA. 2012a. EPA and NHTSA Set Standards to Reduce Greenhouse Gases and Improve Fuel Economy for Model Years 2017–2025 Cars and Light Trucks. U.S. Environmental Protection Agency, Washington, D.C. GCRP 2014. citing Ericksen, P.J., J.S.I. Ingram, and D.M. Liverman. 2009. Food Security and Global Environmental Change: Emerging Challenges. Environmental Science & Policy 12:373–377. GCRP 2014. citing ERS. 2012. Economic Research Service, U.S. Department of Agriculture. Washington, D.C. GCRP 2014. citing FAA. 2012. Federal Aviation Administration: U.S. & Territories Airport Lookup. Federal Aviation Administration. 12-35 FIGURE Updating... X-X FIGURE 14–2 Part D’s discount on brand-name drugs in the coverage gap and defined standard benefit structure has changed over time Individual enrollee’s gross drug spending $12,000 Medicare reinsurance Plan liability Enrollee cost sharing Manufacturer discount Out-of-pocket threshold $10,000 $8,000 Coverage gap 25% $6,000 35% 25% Initial coverage limit $4,000 $2,000 Deductible $0 2018 Note: 2019 2020 “Gross drug spending” refers to amounts paid at the pharmacy before postsale rebates and discounts. The amount of drug spending at which a beneficiary reaches the out-of-pocket (OOP) threshold depends on the mix of brand-name and generic prescriptions he or she fills in the coverage gap. The coverage-gap phase (between the initial coverge limit and OOP threshold) is depicted as it would apply to brand-name drugs for an enrollee who does not receive Part D’s low-income subsidy (LIS). Non-LIS enrollees’ cost sharing for generic drugs in the coverage gap was 44 percent in 2018, is 37 percent in 2019 and will be 25 percent in 2020. Source: MedPAC depiction of Part D benefit structure as set by law. of studies suggested that higher cost sharing in this In InDesign. coverage gap (also called the “donut hole”) decreased rates of medication adherence, primarily for brand-name drugs (Fung et al. 2010, Yu et al. 2016, Zhang et al. 2013, Zhang et al. 2009). Compared with commercial insurance, Part D’s benefit structure is unusual because of the coverage gap. Note: The coverage gap affects enrollees’ OOP spending differently depending on whether the beneficiary receives the LIS. Under law, LIS enrollees experience no coverage gap; Medicare’s low-income cost-sharing subsidy pays for 100 percent of most enrollees’ costs during the coverage- 392 The Medicare prescription drug program (Part D): Status report gap phase minus their nominal copayments. Manufacturers of brand-name drugs are not required to pay any discount for LIS enrollees during the coverage gap, and plan sponsors are not liable for covered benefits until the LIS enrollee reaches the OOP threshold. Although Part D’s cost-sharing assistance offsets the higher burden that LIS enrollees would otherwise face, the current structure of the subsidies may be creating plan and beneficiary incentives that lead to higher program costs (see text box, p. 394). The Patient Protection and Affordable Care Act of 2010 (PPACA) called for gradually lowering cost sharing in the coverage gap from 100 percent to 25 percent by ...
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