Publications

Comprehensive Application of Predictive Modeling to Reduce Overpayments in Medicare and Medicaid

June 2009

Expertise Area: Medicaid and CHIP, Medicare

Financial Impacts on Medicare Beneficiaries if Larger Part D Rebates Are Required for Medicare/Medicaid Dual Eligibles

June 2009

PhRMA commissioned an evaluation of the degree to which changes in rebates for Medicare/Medicaid dual eligibles would create "spillover" impacts on the Part D premiums charged to other Medicare beneficiaries. Ingenix Consulting staff conducted modeling of various scenarios and Lewin staff prepared the written report. Our analyses estimate that if dual eligibles' prescriptions are paid for at Medicaid prices, additional costs will be imposed on Part D participants who are not dual eligibles. These increased monthly costs per beneficiary are estimated to range from $8 - $16, which constitutes an increase of 25% - 50% in the Part D premiums paid by non-dual eligibles.

Client Area: Associations
Expertise Area: Medicaid and CHIP, Medicare

Comparison of VA National Formulary and Formularies of the Highest Enrollment Plans in Medicare Part D and the Federal Employee Health Benefit Program

December 2008

For the Pharmaceutical Research and Manufacturers of America, The Lewin Group  compared the formulary status of drugs commonly used by the Medicare population on the Veterans Affairs National Formulary (VA formulary), the two highest enrollment Medicare Part D plans, and the plan with highest enrollment in the Federal Employee Health Benefit Program (FEHBP).  Lewin first completed this analysis in January 2007 using the 2007 versions of the VA formulary, Medicare Part D formularies, and FEHBP formulary.  This report provides an update to the 2007 analysis.

Client Area: Associations
Expertise Area: Medicare

Assessing the Costs of Performing DXA Services in the Office-based Setting : Final Report

October 2007

Osteoporosis is a disease that is characterized by low bone mass and a deterioration of bone structure that results in bone fragility and an increased risk of fracture. The disease affects 10 million older Americans and is associated with significant mortality and morbidity. An additional 34 million individuals have osteopenia (low bone mass) and are at increased risk of fracture at some time in their lives. Osteoporosis-related fractures represent a serious illness burden and are a major cause of disability among Medicare beneficiaries. Dual-energy X-ray absorptiometry (DXA) is the “gold standard” for diagnosing osteoporosis, using World Health Organization criteria. Amid recent changes in Medicare reimbursement methodology, providers had become concerned that payment for DXA and vertebral fracture assessment (VFA) was below operating costs. However, a systematic study of the cost to perform a DXA procedure had not been conducted. The American Association of Clinical Endocrinologists, the International Society for Clinical Densitometry, The Endocrine Society and the American College of Rheumatology commissioned The Lewin Group to survey office-based providers of DXA, in order to develop estimates of the costs associated with providing DXA services to Medicare beneficiaries. This study should assist policymakers and others to determine whether the current Medicare reimbursement for DXA approximates real world operating costs.

Client Area: Associations
Expertise Area: Evidence-Based Medicine / HTA, Medicare

Formulary of Highest Enrollment Part D Plan Includes More Unique Chemical Compounds than VA National Formulary

March 2007

A number of statements have been made about the comprehensiveness of VA formulary coverage in comparison to Part D formulary coverage. The Pharmaceutical Research and Manufacturers of America requested The Lewin Group to look at certain comparisons made of those formularies. This report presents the results of that examination

Client Area: Associations
Expertise Area: Medicare

Comparison of VA National Formulary and Formularies of the Highest Enrollment Plans in Medicare Part D and the Federal Employee Health Benefit Program

January 2007

The Lewin Group was asked by The Pharmaceutical Research and Manufacturers of America to compare the formulary status of drugs commonly used by the Medicare population on the Veterans Affairs National Formulary, the two highest enrollment Medicare Part D plans, and the plan with the highest enrollment in the Federal Employee Health Benefit Program. This report presents the findings of that comparison.

Client Area: Associations
Expertise Area: Medicare

Beneficiary Choices in Medicare Part D and Plan Features in 2006

September 2006

This analysis, commissioned by the Pharmaceutical Research and Manufacturers of America, sheds new light on how the Medicare prescription drug program is working by assessing the characteristics of plans chosen by beneficiaries. To date, most studies of the Medicare Part D drug benefit have analyzed overall plan offerings and average characteristics without taking into account the enrollment choices of Medicare beneficiaries. This analysis provides a more complete picture by using beneficiary choice to weight plan characteristics, since beneficiaries have disproportionately chosen to enroll in some plans; 64% of enrollment in concentrated in plans offered by four plan sponsors. The Lewin study finds that, on average, beneficiaries have chosen plans with lower premiums, reduced or zero deductibles, and broader formularies.

Client Area: Associations
Expertise Area: Medicare

Medicare Part D Factsheets

June 2006

The Medicare drug benefit, which went into effect in January 2006, has resulted in an increase in the number of Medicare beneficiaries with comprehensive prescription drug coverage; nine out of ten Medicare beneficiaries now have comprehensive prescription drug coverage. The Lewin Group analyzed how drug coverage has changed for seniors since implementation of the new Medicare drug benefit and developed a set of factsheets indicating what additional coverage is available to seniors in all 50 states and the District of Columbia.

Client Area: Associations
Expertise Area: Medicare

Chronic Health Conditions & the New Medicare Part D Benefit: Savings on Frequently Used Medications: Executive Summary

April 2006

This study, commissioned by the Healthcare Leadership Council, analyzes savings available to Medicare beneficiaries with common chronic conditions who enroll in a Prescription Drug Plan (PDP). The five chronic conditions studied are arthritis, diabetes, hypertension, osteoporosis and respiratory illness. 84 percent of Medicare beneficiaries report having at least one of these most common diagnoses. Lewin finds that, nationwide, beneficiaries can save 43 to 58 percent by enrolling in one of the 5 PDPs with the lowest costs. The executive summary presents information at a national level by chronic condition. Available in separate files are state level findings for Alabama-Kentucky, Louisiana-North Dakota, and Ohio-Wyoming. Also available in separate files are the appendices which provide additional detailed data for Alabama-Kentucky, Louisiana-North Dakota, and Ohio-Wyoming.

Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness, Medicare

Savings from the Medicare Drug Benefit for Beneficiaries with Chronic Conditions

January 2006

The purpose of this study is to estimate the potential savings offered throught the new Medicare prescription drug benefit to Medicare beneficiaries living with chronic conditions. For this study, The Lewin Group examined drug spending data for Medicare beneficiaries who face a decision whether to enroll in the Medicare drug benefit. The study focuses primarily on beneficiaries with chronic conditions because these beneficiaries have higher average drug costs than beneficiaries without chronic conditions. The specific chronic conditions included in this study are: Alzheimer's, arthritis, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, mental disorder, osteoporosis, and Parkinson's.

Client Area: Associations
Expertise Area: Medicare