Magazine article Drug Topics

Medicare HMOs with Rx Benefits on the Upswing

Magazine article Drug Topics

Medicare HMOs with Rx Benefits on the Upswing

Article excerpt

Althougn Medicare does not pay for an outpatient pharmacy benefit, the current trend of more and more health maintenance organizations offering this benefit to Medicare enrollees will continue, predicted an official from the Health Care Financing Administration.

That was the word from Philip Doerr, acting director of operations, operations and oversight team, office of managed care, HCFA, speaking at the Academy of Managed Care Pharmacy's recent conference on Medicaid and Medicare, held in Baltimore. He pointed to several factors driving the rise in pharmacy benefits for HMO-enrolled Medicare recipients, including:

* The percentage of the U.S. population becoming eligible for Medicare is growing rapidly. While 12.7% of the U.S. population now qualifies for Medicare, that percentage will swell to 18% by the year 2020, he predicted. The baby boomer generation is on its way. Even now, about 10,000 people reach age 50 every day--one every seven seconds.

Keep in mind that the Social Security administration estimates that 150,000240,000 people qualify for Medicare for the first time each month, he added.

* A growing number of Medicare beneficiaries are joining HMOs, he said. Since 1982, when Medicare legislation was passed that allowed HMOs to start enrolling them, close to four million Medicare beneficiaries have joined some form of managed care contract.

The states with the greatest number of Medicare recipients enrolled in HMOs are led by California, with over one million in risk contracts, followed by Florida and Arizona, he noted. …

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