Medicare Part D: What's New in 2007

Dr Rogers is Medical Officer, Office of the Administrator, and Director, Physicians Regulatory Issues Team, Centers for Medicare & Medicaid Services, Department of Health and Human Services

Physicians and pharmacies are getting more facile with Medicare Part D. Although the program has been a source of frustration and extra work for physicians, it has been a resounding success for most Medicare beneficiaries. This past year, 90% of Medicare beneficiaries enjoyed drug coverage. Nearly 50% of these people previously had no drug coverage, or only sporadic coverage, before Congress created the Part D benefit. The average national monthly premium in 2006 was $24, which was 35% lower than the initial estimate of $37. The net cost of the program is nearly $200 billion less than estimated, thanks to aggressive competition among the many drug plans. Finally, 5 recent surveys reveal ≥75% beneficiary satisfaction with the program.

Many bugs have been worked out, but work remains to be done in 2007 to minimize the adverse impact of Part D on physician practices. One area of huge concern is the potential impact of a plan change by a beneficiary on access to medications.

The box on the right outlines the steps we have taken to ensure that patients who change plans can get their medications during the transition period. The basic requirement is that the new plan must provide patients with 30 days of the medication their old plan was covering, to give enrollees time to get a prescription for a comparable drug covered by the new plan or to file an exception request.

Vaccine Coverage

Until President Bush signed the Tax Relief and Health Care Act on December 20, 2006, Medicare could not pay for the administration of most vaccines, with a few exceptions (ie, influenza, pneumococcal, and hepatitis B vaccine, and tetanus toxoid).

Now, Medicare is permitted to pay for the administration of all vaccines covered by Part D. Vaccine administration will be billed to Part B in 2007; in 2008 it will be paid by Part D plans, according to Section 202 of Title 2 of the Act.

Physician Bonus

Next month, I will address provisions that will affect physicians, such as expanding the recovery audit contractor program to cover all 50 states and the 1.5% bonus to physicians who report quality measures to Medicare, beginning in July 2007.