Talk:Medicare Part D

message: *EOM
*The best article currently on wikipedia explaining a formulary is British National Formulary, which is not that great and obviously is specific to England.  A formulary is a list of drugs that one specific plan through a specific provider will cover.  Medicare D has a formulary and then the different providers can cover a percentage of that - usually about the low 70% range on the very low end all the way up to 100% (with restrictions of course) in the case of certain plans available through Humana and AARP-United and a few others.  Does that answer your question?--Hraefen 17:44, 21 February 2006 (UTC)
replies: text: Part D does not have a formulary. A formulary includes an explicit schema detailing exactly what drugs are covered, and under what conditions, including such things as cost sharing level (copay). Part D coverage instead has interpretative exclusionary regulations, based in US law, which some have mistakenly described as a formulary. As an example of efforts to make clear that there is no formulary legally authorized for Part D, the legislation recently passed by the US House as "H.R. 4 - Requiring Medicare to Negotiate Lower Prescription Drug Prices" as part of the Speaker Nancy Pelosi's 100-Hour Plan explicitly states that the bill does not authorize HHS to establish or require a particular formulary. There would be no need for this wording if a formulary currently existed. However the individual plans do establish their own formularies, within certain restrictions governed by CMS. -- 12.106.111.10 23:23, 1 February 2007 (UTC)
thread_title:  What is a formulary? 

message: Although there is an entire section dedicated to the implementation issues of Medicare Part D, there is no section reporting on the progress it has made or the possible advantages it may have (projected costs, although initially higher, have been estimated to be lower as of late, impacting possible clawback rates).  Of course, state-sponsored dogma such as Secretary Leavitt's frequent Part D updates is undesirable, but the future of the plan is very much in question and there are arguments for how it may outperform other nations' prescription drug benefits (as well as those mentioned in this article for how it may ultimately fail).  In the next few weeks, I will endeavor to unfold some of these arguments, but if anybody is an expert in the area, they could help flesh out this description. Poa02003 16:40, 11 July 2006 (UTC)
thread_title:  I wonder about the neutrality of this page 

message: Can anyone direct me to info that claims duals can move plans monthly? This has not been my experience as I handle Part D for a fortune 500 company.EmDeeEm 23:49, 12 September 2006 (UTC)
thread_title:  Dual Eligible 

message: Medicare spells it "donut hole" here.  Perhaps we might be consistent with the name the government is using? --Chrispounds 20:22, 17 November 2006 (UTC)
thread_title: Donut hole

message: Perhaps it's against my better judgement, but I'd like to mention that I work for Aetna Inc.  The literature we've been trained on states that medicare maintains a formulary list and that legally all part d carriers must conform to this list.  Several of the customers I’ve spoken to disagree with this & so does this article.  Looking at the reference cited (ref 13) I can’t find any place where it’s directly stated otherwise, though the wording seems to suggest it indirectly.  Does anyone have a more direct reference for this piece of information?
:Try the CMS part D PDP finder. Search for a few common drugs and look at a few of the plans links, it will tell you if they cover the drug or not. for most drugs, some will, others will not. does that answer your question? Pdbailey (talk) 03:31, 9 April 2008 (UTC)
thread_title:  Missinformation? 

message: I think some of the recent (April 7-9, 2007) edits by Nbauman contain some interesting information, but I think they also turn the Wikipedia entry into an Anti-Medicare Part D propaganda piece.  For instance, the first line of the Program Specifics heading is now a quote about how confusing the options are.  I have no issue with putting attributed quotes about problems with Medicare in the Criticisms section, but the latest additions compromise NPOV.  I'm going to tag the article as such for now until we get a better edit.
Let me be clear, I support keeping a lot of the added information in the article, but would prefer a more objective reading in the body, limiting criticisms to the criticisms section.  Another example:  The number of members enrolled in Medicare Part D is fairly objective.  The fact that the vast majority of those members did not enroll voluntarily is relevant, but I feel it should be in a separate section.  Happy to challenged here.  Jargent 16:37, 11 April 2007 (UTC)
thread_title:  Losing encyclopedic tone? 

message: While they are certainly related sounding plans, medicare part D is different than the perscription plans provided under the medicare advantage plans. 75.132.36.150 15:15, 12 August 2007 (UTC)
thread_title:  Medicare Advantage Perscription Plan 

message: I am an 86 year old WWII veteran (100th Infantry Division).  In January 2006, my wife and I signed up for the basic Medicare Prescription Drug Insurance  from Humana (one of the providers of  that insurance) at a cost of $5.41 per month per person.
By January 2009, the monthly cost has risen to $41.90 per person. That is a 756 percent increase in 3 years!!  That is not "free market capitalism" ... it is outright "highway robbery" !! We seniors are being abused by such despicable bait-and-switch tactics. 
I believe it would be appropriate to include a discussion of the exorbitant price increase as a new section of this article. Not to do so would be a sad omission. mbeychok (talk) 21:21, 4 March 2009 (UTC)
replies: text: I cannot speak to the specifics of the Humana PDP.  However, the premium cost increases cited above may be due to the leveraging effect of medical inflation compared to lower or no increases in subsubsidies.  For instance, assume the full cost of a drug program is $100 per month and the subsidy from the Federal Government is $95 (example only).  If prescription drug inflation (including increases to utilization) is 10% increasing the cost to $110, and the subsidy increases at only 4% (example only) increasing the subsidy to $98.80, then the cost increase to the participant goes up 124% from $5 to $11.20.Jmhager (talk) 12:17, 9 February 2011 (UTC)
thread_title:  Cost of Medicare prescription drug insurance has risen 756% in 3 years!! It is a major bait-and-switch scam. 

message: I may be wrong so please let me know but in the total cost of the program section the article states:
"In August 2008, CMS estimated that the 10-year cost of the program would be $395 billion, down from the original estimate of $634 billion."
First- the link cited (15) is dead.
Second- The number of $395 billion appears to be from the CBO projected estimate of Nov 2003 not August 2008 as the article states.
Please see this link http://www.medicalnewstoday.com/articles/28942.php
It states:
"When the law was enacted in November 2003, the Congressional Budget Office projected the 10-year cost at $395 billion."
Third- Here are other estimates from the Heritage Foundation at http://www.heritage.org/research/healthcare/bg1849.cfm
"When Congress enacted the Medicare Moderniza­tion Act (MMA) in November 2003, it relied on cost estimates by the Congressional Budget Office (CBO). The CBO estimated the 10-year cost of the drug pro­visions at $394 billion for the period 2004 to 2013.
The Centers for Medicare and Medicaid Services (CMS), the agency that runs the Medicare program, gen­erated its own estimate in 2003 and has continued to do so every year since the bill’s enactment. Though not made public until 2004, the CMS’s 2003 estimate was $534 billion for the period 2004 to 2013. In CMS’s February 2005 estimate, the 10-year price tag of the drug provision is $724 billion for the period 2006 to 2015."
Forth- The latest estimates from: BOARDS OF TRUSTEES OF THE FEDERAL HOSPITAL INSURANCE AND FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUNDS, Washington, D.C., May 12, 2009
located at: http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf
gives these nummbers (billions) for the projected, intermediate cost range, total expenditures for 2009 to 2018 respectively:
     63     
     66.2     
     72.7     
     79.8     
     86.7     
     94.8     
     104.8     
     114.6     
     127.2     
     140.8     
The total cost of the program from what I can see for these 10 years is $999.90 billion based on the INTERMEDIATE cost numbers.
The ten year cost went from:
2003 $395 billion
2004 $394 billion *made public in 2004
2005 $724 billion
2008 $999.9 billion *call it an even trillion over 10 years (remind you of another cost estimate)
I know this is a sliding 10 year window but there is a serious error from what I can see and the latest numbers should at least be updated.
I have never done this so any advice would be highly appreciated...  
Markdart (talk) 19:10, 22 January 2010 (UTC)
replies: text: You're using the wrong numbers to reach that result - the numbers you've cited are the total expenditures, not the amount of money coming out of general revenues. If you subtract premium payments and transfers from states, you get the actual net cost of the program, which is what all the other numbers you've cited were referring to. According to the Trustees, those numbers are:
48.5
50.7
55.5
60.8
66.1
72.4
79.9
88.2
97.4
107.8
That adds up to $727.3b over the 2009-2018 period. Leuchars (talk) 18:25, 9 February 2010 (UTC)
thread_title:  The total cost of the program cited here is way off from what I can see and way old 

message: Current "Program costs" Section is:
As of January 2006, the expected per capita drug spending, reported by the Department of Health and Human services, was $2,250, making the total cost of the program $42.75 Billion.[6] This budget compares with revenues of $54 Billion for Pfizer and $48.6 Billion for Johnson & Johnson, the two largest pharmaceutical companies. Kaiser Family Foundation, estimates the 2006 costs at $37.4 billion.[2] Total costs through 2015 are estimated to be $724 billion. Some of these revenues will be provided by "clawback" of revenues currently provided to the states for Medicaid. The "clawback" is a mechanism by which federal expenditures that benefit states (specifically regarding dual eligibles) are reimbursed back to the federal government. This reimbursement starts at 90%, but then falls to 75% in 2015. Figures also depend on per capita estimates of dual eligible expenditures and the number of dual eligibles that receive benefits.
As of January 2008, total Medicare spending for prescription drug benefits was projected to drop from $40.5 billion in 2007 to $36 billion in 2008. One factor contributing to lower costs is the increased use of generic drugs.[4] Shortly after the release of the 2008 Medicare Trustees' Report,[25] the Chief Actuary testified that the 10-year cost of Medicare drug benefit is 37% lower than originally projected in 2003, and 17% percent lower than last year's projections.[26]
In August 2008, CMS estimated that the 10-year cost of the program would be $395 billion, down from the original estimate of $634 billion.[15] (note: This link is dead.) In late October 2008, USA Today reported that costs were down by $6 billion, or 12%, for the fiscal year ended September 30. Costs for the program were approximately one third less than originally predicted.[27]
Proposed New "Program costs" Section:
As of the end of year 2008, the average annual per beneficiary cost spending for Part D, reported by the Department of Health and Human Services, was $1,517 [44], making the total expenditures of the program for 2008 $49.3 (billions).  Total intermediate, projected expenditures from 2009 through 2018 are estimated to be $999.9 (billions). [45]
New "Program costs" References:
44.	^ 2009 ANNUAL REPORT OF THE BOARDS OF TRUSTEES OF THE FEDERAL HOSPITAL INSURANCE AND FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUNDS, Table II.B1.—Medicare Data for Calendar Year 2008, Page 5 (Page 11 in pdf) 
45.	^ 2009 ANNUAL REPORT OF THE BOARDS OF TRUSTEES OF THE FEDERAL HOSPITAL INSURANCE AND FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUNDS, Table III.C19.—Operations of the Part D Account in the SMI Trust Fund (Cash Basis) during Calendar Years 2004-2018, Page 120 (Page 126 in pdf) 
Notes for Talk section viewers:
- There are many links that are dead in this article.  The data is also very old.  
- I will try to update the article one section at a time starting with the program cost section.  If there are no objections or requested additions I will update the "Program costs" section on 2/1
- The hyperlink for reference 44 is http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf
- The hyperlink for refernce 45 is also http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf
- Any comments or feedback is highly welcome...
Markdart (talk) 21:09, 25 January 2010 (UTC)
thread_title:  Proposed change to "Program costs" section 

message: The citation link in "criticisms" about drug costs compared to VA coverage is bad. It is number 32. Dude6935 (talk) 00:30, 2 February 2010 (UTC)
thread_title:  Bad Citation 

message: There is updated 2010 info on plan premiums, as well as updated stats on average costs. I don't have time to go through and make them all but much is available through Kaiser's Medicare Primer. Zach99998 (talk) 18:30, 14 June 2010 (UTC)
replies: text: Don't link to Kaiser in the main article. I've updated the LIS cost chart with the 2010 info. There's no specialty copay level for LIS beneficiaries anymore; that all comes up as brand now. Annorax (talk) 05:08, 4 July 2010 (UTC)
replies: text: Why not link to Kaiser in the main article? Also, where did you find the LIS 2010 information? Zach99998 (talk) 02:45, 26 July 2010 (UTC)
thread_title:  2010 Updated info 

message: Hello.  I am finding myself repeatedly archiving links on this page.  This usually happens when the archive doesn't recognize the archive to be good.
This could be because the link is either a redirect, or I am unknowingly archiving a dead link.Please check the following links to see if it's redirecting, or in anyway bad, and fix them, if possible.
* http://www.washingtonpost.com/wp-dyn/content/article/2006/11/25/AR2006112500919.html
In any event this will be the only notification in regards to these links, and I will discontinue my attempts to archive the page.
Cheers.—cyberbot IITalk to my owner:Online 16:13, 5 July 2015 (UTC)
thread_title:  Trouble archiving links on the article 

message: Hello fellow Wikipedians,
I have just attempted to maintain the sources on Medicare Part D.  I managed to add archive links to 2 , out of the total 2 I modified, whiling tagging 0 as dead.
Please take a moment to review my changes to verify that the change is accurate and correct.  If it isn't, please modify it accordingly and if necessary tag that source with  to keep Cyberbot from modifying it any further.  Alternatively, you can also add  to keep me off the page's sources altogether.  Let other users know that you have reviewed my edit by leaving a comment on this post.
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*Added archive http://web.archive.org/web/20070822005451/http://www.cms.hhs.gov:80/PrescriptionDrugCovGenIn/02_EnrollmentData.asp to http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/02_EnrollmentData.asp
*Added archive http://web.archive.org/web/20101007210145/http://www.medicare.gov:80/Contacts/staticpages/ships.aspx to http://www.medicare.gov/contacts/staticpages/ships.aspx
Cheers.—cyberbot IITalk to my owner:Online 16:13, 5 July 2015 (UTC)
thread_title:  Sources modified on [[Medicare Part D]] 

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I have just modified one external link on Medicare Part D. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:
*Added archive https://web.archive.org/web/20060406005133/https://www.medicare.gov/publications/pubs/pdf/10050.pdf to http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf
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thread_title:  External links modified 

message: I’m from Ohio never been on drug plan I have Medicare can I still get on it  Sissyboothmk (talk) 16:06, 10 January 2018 (UTC)
thread_title:  Getting on new drug plan 

message: In spite of updated/fixed links, the article as a whole is woefully outdated -- and necessarily so, because the Medicare rules change every year! Keeping up with annual changes like this (the tax code is, of course, another example) is a huge challenge. Suggest restructuring the article into: (1) historical background, (2) a current year baseline (pick a year), and (3) a new section each year thereafter, that describes whatever significant changes in that year. G41rn8 (talk) 19:32, 19 January 2018 (UTC)
thread_title:  Article is outdated 

message: The entire section consists almost exclusively of subjective claims, rather than facts, and provides sources for neither.
:I agree that the history section had some serious problems. I rewrote it to try to be more fact-based and to include a broader historical context for the program. --Burritosol (talk) 18:40, 19 July 2021 (UTC)
thread_title:  The History section of this article is blatantly an opinion piece 

message: — Assignment last updated by ChrisMisu (talk) 18:26, 1 December 2023 (UTC)
thread_title: Wiki Education assignment: Research Process and Methodology - FA23 - Sect 202 - Thu