Monday, October 11, 2004

Medicare Demonstration PPOs
A September GAO report to the House Finance Committeein Adobe Acrobat format - "Preferred provider organizations (PPO) are more prevalent than other types of health plans in the private market, but, in 2003, only six PPOs contracted to serve Medicare beneficiaries in Medicare+Choice (M+C), Medicare’s private health plan option. In recent years, the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, initiated two demonstrations that include a total of 34 PPOs. GAO (1) described how CMS used its statutory authority to conduct the two demonstrations, (2) assessed the extent to which demonstration PPOs expanded access to Medicare health plans and attracted enrollees in 2003, (3) compared CMS’s estimates of out-of-pocket costs beneficiaries incurred in demonstration PPOs with those of other types of coverage, including fee-for-service (FFS) Medicare, M+C plans, and Medigap policies in 2003, and (4) determined the effects of demonstration PPOs on Medicare spending."  
  

Safe and Effective Approaches to Lowering State Prescription Drug Costs: Best Practices Among State Medicaid Drug Programs
A September CMS/HHS report in Adobe Acrobat format - "As a result of increasing prescription drug costs, State Medicaid programs have implemented a variety of cost-containment mechanisms in their drug programs over the past few years. These mechanisms have allowed states to reduce their pharmacy expenditures and maintain beneficiary access to a vital part of their overall healthcare. This paper describes some of these cost-containment mechanisms and highlights several states that have achieved reduced costs with each technique. In general, states have not yet taken advantage of all of these approaches. CMS can provide consultation and support to assist states in using these and other methods to lower their drug costs without compromising quality of care."