Medicare Part D policy update and implications for 2010.

Area of Science:

• Pharmaceutical Policy
• Health Services Research
• Public Health

Background:

• Medicare Part D, established in 2006, has undergone significant modifications.
• Changes are driven by both legislative statutes and Centers for Medicare & Medicaid Services (CMS) guidance.

Purpose of the Study:

• To comprehensively review and catalog Medicare Part D benefit changes for 2010.
• To interpret the implications of these 2010 changes for various stakeholders, including plan sponsors, pharmacists, beneficiaries, and pharmaceutical companies.

Main Methods:

• Analysis of policy statements and communications from CMS issued between January 1, 2009, and November 30, 2009.
• Review of relevant Medicare Part D publications to identify benefit modifications.

Main Results:

• Key 2010 changes include an updated standard benefit design and a revised definition of negotiated prices.
• Introduction of utilization management limitations and a nonmatched National Drug Code list.
• New guidance was issued for medication therapy management programs.

Conclusions:

• The 2010 Medicare Part D benefit modifications represent a positive development for beneficiaries.
• Despite the continued existence of the coverage gap for some, there is a clear trend towards a more robust benefit structure and improved patient protections.