Medicare Part D

Publications

Alphabetical list. You can also view by publication date.

• Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
  Date: 07 / 2001
  Author(s): Michelle M. Casey, Jill Klingner, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Health services, Legislation and regulation, Medicare Part D, Pharmacy and prescription drugs, Workforce
  Report Number: Working Paper No. 36
  Describes the current status of rural retail pharmacies in the three states; examines the availability of pharmacy services in rural areas of the states; and analyzes regulatory and policy issues that affect the delivery of pharmacy services in rural areas. Among the findings are that pharmacy access problems in the states are not primarily due to closure of rural pharmacies in recent years; relief coverage is a major concern for many rural pharmacies; financial access to pharmacy services is a major concern in rural areas of the states; the financial viability of rural pharmacies is a key policy issue; and the addition of a Medicare prescription benefit may have a substantial negative impact on the financial status of rural pharmacies. Makes several recommendations pertaining to the capacity of colleges of pharmacy to produce an adequate supply of rural pharmacists; options for providing affordable relief coverage for rural pharmacists; financial access to prescription drug coverage for the elderly and other vulnerable populations; and the potential financial impact of a Medicare prescription benefit on rural pharmacies.
• April 2009 Rural Enrollment in Medicare Advantage: Growth in PPOs Outpacing Growth in PFFS
  Date: 05 / 2009
  Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare Advantage (MA), Medicare Part D
  Report Number: 2009-4
  Private fee-for-service (PFFS) plans dominate enrollment in rural areas and have accounted for much of the program's expansion since 2005. However, from December 2008 through April 2009 enrollment growth of preferred provider organization (PPO) plans, both nationally and in rural areas, was double the enrollment growth of PFFS plans.
• Designing a Medicare Drug Benefit: Balancing Government-Based and Market-Based Approaches, the Implications for Rural Beneficiaries
  Date: 01 / 2003
  Research center: Walsh Center for Rural Health Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Examines the relationship between a variety of design characteristics of a Medicare prescription drug benefit and their likely impact on rural areas. The research is based on an analysis of three competing legislative proposals, the House passed proposal (HR 4954), the "Tripartisan" proposal (S 2729), and the Graham proposal (S 2625). In addition, there is an analysis of data from the Medicare Current Beneficiary Survey, pharmacy benefit managers, discussions with various state and federal policy makers, and reviews of published literature. The study finds that the different prescription drug proposals will have positive implications for rural areas and address the lack of access to Medicare+Choice drug coverage in rural areas. Rural pharmacies may see a change in revenue, but the actual result of the changes has not been studied.
• Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
  Date: 08 / 2000
  Author(s): Andrew F. Coburn, Erika C. Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
• Eligible But Not Enrolled? Potential for Targeting Over a Half-Million Rural Medicare Beneficiaries for Enrollment in the Low-Income Subsidy Prescription Drug Program (Policy Brief)
  Date: 12 / 2008
  Author(s): Timothy D. McBride, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Part D
  Report Number: Brief No. 2008-5
  The Medicare Part D low-income supplement (LIS) is designed to help low-income persons access the prescription drug benefit with reduced premiums and lower out-of-pocket costs. To date, estimates suggest that almost 80% of the persons eligible for the LIS are participating in the program. But despite efforts by CMS and its partners to enroll as many eligible persons as possible, 5.6% of rural Medicare beneficiaries and 3.7% of urban Medicare beneficiaries are estimated to be eligible for but not enrolled in the LIS program. Information in this brief and the accompanying state tables could help CMS partners (including state and county agencies) target counties with high likelihood of identifying and enrolling LIS-eligible beneficiaries. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
  Date: 01 / 2007
  Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare Part D
  Report Number: Rural Policy Brief Vol. 12, No. 1 (PB2007-1)
  Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United States. Updates findings presented in RUPRI Center policy brief PB2006-8. Maps showing the percent of rural persons enrolled in Part D plans are available: black and white map, color map.
• Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
  Date: 2007
  Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Citation: Journal of Rural Health, 23(4), 286–293
  Describes first-hand reports from rural pharmacist-owners about their experiences with Medicare Part D plans in the first 7 months of 2006 in order to gain a more thorough understanding of the challenges faced by rural independent pharmacies as a result of program implementation.
• Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
  Date: 11 / 2006
  Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Report Number: Working Paper No. 87 (NC), Policy Paper P2006-3 (RUPRI)
  Case study describing first-hand reports from 12 rural independent pharmacists in seven states about their experiences with Medicare Part D plans (PDPs) in the first seven months of 2006. The rural independent pharmacists interviewed are experiencing major changes in payment, administrative burden, and interaction with patients as a result of the shift of patients into Medicare Part D plans. Previously, these patients were mostly non-covered cash or Medicaid-covered clients. Two consequences are apparent in the data collected: 1) Payment per prescription is lower from Medicare PDPs than from either non-covered cash or Medicaid, and in some instances payment from PDPs is less than the combined cost of stocking the medications and dispensing them, representing a reduction in revenue; and 2)The number of plans that provide Part D benefits greatly exceeds the two payment sources pharmacists previously dealt with, representing an increase in administrative burden for independent pharmacies. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Pre-Implementation Prescription Volume and Payment Sources in Rural and Urban Areas
  Date: 2005
  Author(s): Erin P. Fraher, Rebecca T. Slifkin, Laura Smith, Randy Randolph, Matthew Rudolf, George M. Holmes
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health care financing, Health policy, Medicare Part D, Pharmacy and prescription drugs
  Citation: Journal of Rural Health, 21(2), 114-121
  Presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs. urban areas. Together, these data provide a baseline for evaluating how implementation of the MMA may affect the financial viability of rural independent pharmacies. The authors found that the volume of mail-order prescriptions is small. Rural providers prescribed fewer retail and mail-order prescriptions per person, but more units per person. Rural areas have a higher percentage of prescriptions paid for by cash (18% vs. 13%) and Medicaid (16% vs. 10%) and a lower percentage of third-party payers than urban areas. Significant variation in volume and payer type exists between states. The authors conclude that rural, independent pharmacies may be negatively affected by MMA implementation as business shifts from cash to third-party reimbursement. The high degree of variation between states also has potentially important implications for the implementation of Prescription Drug Plan regions under MMA.
• Independently Owned Pharmacy Closures in Rural America (Policy Brief)
  Date: 07 / 2008
  Author(s): Donald Klepser, Liyan Xu, Fred Ullrich, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare Advantage (MA), Medicare Part D, Pharmacy and prescription drugs
  Report Number: 2008-2
  The purpose of this policy brief is to provide policy makers, researchers, and stakeholders with information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 to 2008. This period coincides with the implementation of two major policies related to payment for prescription medications: Medicare prescription drug discount cards were introduced on January 1, 2004, and the Medicare prescription drug benefit began on January 1, 2006. In this brief, we focus on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
  Date: 06 / 2009
  Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Part D, Medicare Prospective Payment System (PPS)
  Report Number: 2009-7
  A changing landscape is emerging for rural Medicare Advantage (MA) enrollment in 2009 as rapid growth in preferred provider organization (PPO) plan enrollment is coupled with a decline in the growth rate of enrollment in private fee-for-service (PFFS) plans. Enrollment in MA plans has continued to climb in 2009, but it has been impacted by the slowed rate of growth in PFFS plans, which cover over half of MA enrollees in rural areas. The growth in PPO enrollment in recent months is likely tied to changes in policy that have encouraged the growth of new PPO plans, enrollment in existing PPO plans, and expansions of the service areas of existing plans.
• Medicare Beneficiaries’ Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans
  Date: 01 / 2009
  Author(s): Victoria A Freeman, Indira Richardson, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  Report Number: Final Report No. 95
  Describes the contracting patterns of sole rural community pharmacies to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
• Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
  Date: 04 / 2006
  Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare Part D
  Report Number: Rural Policy Brief Vol. 10, No. 8 (PB2006-8 )
  Provides a first snapshot of enrollment in Medicare Part D in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under this program. These early findings show mixed results for the Medicare prescription drug plan (PDP) in rural areas, with enrollment in the Medicare stand-alone PDP higher in rural areas (21%) than in urban areas (13%). However, this is balanced by low enrollment in MA-PD plans in rural areas, which offer relatively less generous plan choices to rural persons. Additionally, enrollment in employer and federal plans is lower in rural areas (20%) than in urban areas (24%). Finally, the relatively high enrollment in Part D in rural areas reflects the high enrollment of Medicaid dual eligibles also covered by Medicare, who were not enrolled in Part D voluntarily.
• Medicare Prescription Drug, Improvement, And Modernization Act Of 2003, (P.L. 108-173): A Summary Of Provisions Important To Rural Health Care Delivery
  Date: 01 / 2004
  Author(s): Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Report Number: Policy Paper P2004-1
  Provides a wide audience of rural health policymakers, advocates, and researchers a consolidated summary of legislative provisions contained in Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) that have particular meaning to the delivery of services in rural areas. Includes information on how this Act will impact beneficiaries, health care access, and payments to rural health care providers.
• One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
  Date: 09 / 2007
  Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Report Number: Final Report No. 92 (NC), Final Report No. P2007-1 (RUPRI)
  Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A findings brief is also available. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
  Date: 10 / 2007
  Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Report Number: Findings Brief No. 83
  Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A final report is also available. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• Preparing for Medicare Part D: An Opportunity for State Offices of Rural Health and State Rural Health Associations
  Date: 08 / 2005
  Author(s): Keith J. Mueller, Lisa Bottsford
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare Part D
  Report Number: Rural Policy Brief Vol. 10, No. 2 (PB2005-2 )
  Keeping with their organizational missions to improve and promote the health of rural Americans, state offices of rural health and state rural health associations have an inherent interest in helping beneficiaries access necessary health care services, including prescription medications. Implementation of Part D creates an opportunity to help beneficiaries through leadership, by connecting beneficiaries and those who serve them to resources that will help them react appropriately to changes in the program.
• Rural Beneficiaries' Projected Drug Coverage Under Three Medicare Prescription Drug Proposals
  Date: 06 / 2003
  Research center: Walsh Center for Rural Health Analysis
  Topics: Medicare, Medicare Part D
  Report Number: P 2003-1
  Estimates the expected increase in urban and rural Medicare beneficiaries eligible for drug coverage under three current Medicare prescription drug proposals. Also gives an estimate of the urban and rural per capita federal payments for drug coverage under the three proposals. Finds that total dollar impact of the three proposals is driven by their generosity. The costliest offers the greatest taxpayer-funded benefits. Per dollar of spending, the urban/rural division of federal drug outlays differs across the proposals. The Administration proposal would result in much higher per-capita federal drug spending in rural areas than urban ones. Congressional Republican and Democratic proposals show smaller rural-urban differences. Concludes that higher poverty and lower current drug coverage in rural areas affect projected spending under Medicare drug proposals. Per dollar of spending, the Administration's proposal to focus spending on near-poor without current coverage strongly favors rural areas. Congressional Democratic and Republican proposals subsidize coverage for all, including those currently with and without coverage. The urban-rural split of federal spending under those proposals depends on the extent to which the currently uninsured are willing to take up the newly offered benefit.
• Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
  Date: 08 / 2004
  Author(s): Curt Mueller, Keith Mueller, Janet Sutton
  Research centers: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Report Number: Walsh W Series No. 6, RUPRI P2004-6
  Provides in chart form sections of the MMA which were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policymakers. The particular sections are cited and implications for rural health services are indicated. Most of the sections identified are concerned with access to prescription drug coverage and the impact of the proposed legislation on rural pharmacies. The primary focus is on rules that will affect providers of drug coverage; this policy paper does not focus on rural dimensions of coverage from the insurance providers' perspective.
• Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (Findings Brief)
  Date: 02 / 2009
  Author(s): Victoria Freeman, Indira Richardson, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Medicare Part D, Pharmacy and prescription drugs
  This findings brief describes the contracting rates of sole rural community pharmacies in 16 states to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.

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• Medicare (72 items)
• Pharmacy and prescription drugs (34 items)