Transcript Title Slide Goes Here

State Specific Example:
Texas
The intersection of business
strategy and public policy
Exits and Entrances to the LIS Market in Texas Will
Result in the Shift of Many Lives in 2008
2007 Auto-Enrollment Eligible Plans (Texas)
2008 Auto-Enrollment Eligible Plans (Texas)
Plans Eligible for Auto-Enrollment Lives in 2007 and 2008
BravoRx
CIGNA Medicare Rx Plan One
Health Net Orange Option 1
HealthSpring Prescription Drug Plan
Community Care Rx Basic
Prescription Pathway Bronze Plan
Advantage Star Plan by Rx America
WellCare Classic*
Plans Not Eligible to Gain New LIS Lives in 2008, but Retaining LIS Enrollees from 2006 and 2007
Blue MedicareRx Standard
First Health Part D - Premier
Exits from the LIS Market
Entrants to Auto-Enrollment Market
AARP MedicareRx Preferred
AARP MedicareRx Saver
Humana PDP Standard
MedicareRx Rewards Value**
WellCare Signature*
Aetna Medicare Rx Essentials
Health Net Orange Option 2
Scott and White Health Plan Texas Rx Value
SilverScript
MedicareRx Rewards Standard**
Source: Avalere Health analysis using DataFrame®, a proprietary database of Medicare Part D plan features.
2008 data from November 2007; 2007 data from November 2006.
*Lives covered by WellCare Signature will be shifted to WellCare Classic in 2008. **Lives covered by MedicareRx
Rewards Value will be shifted to MedicareRx Rewards Standard in 2008.
© Avalere Health LLC
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Plans Gaining LIS Lives in Texas Cover Fewer Drugs and
Apply More Utilization Management Than Plans Losing Lives*
PDP Offering (Texas)
Plans Losing All Dual Eligible Lives in 2008
AARP MedicareRx Preferred
AARP MedicareRx Saver
Humana PDP Standard
MedicareRx Rewards Value**
WellCare Signature***
Average of Plans Losing All Dual Eligible Lives
Plans Gaining Dual Eligible Lives in 2008
Advantage Star Plan by Rx America
Aetna MedicareRx Essentials
BravoRx
CIGNA Medicare Rx Plan One
Community Care Rx Basic
Health Net Orange Option 1
Health Net Orange Option 2
HealthSpring Prescription Drug Plan
MedicareRx Rewards Standard**
Prescription Pathway Bronze Plan
Scott and White Health Plan Texas Rx Value
SilverScript
WellCare Classic***
Average of All Plans Gaining Lives in 2008
# Drugs in
2007
# Drugs in
2008
% Brand in
2007
% Brand in % Drugs with % Drugs with
2008
PA 2007
PA 2008
3,763
3,167
3,752
2,387
1,115
2,837
2,627
2,184
2,623
1,818
1,121
2,075
56%
48%
56%
40%
45%
50%
64%
57%
64%
50%
48%
57%
5%
7%
6%
7%
10%
6%
8%
11%
6%
11%
13%
10%
1,568
2,232
1,999
3,630
1,835
2,754
3,737
1,853
n/a
1,462
1,134
1,470
1,115
2,066
1,370
2,588
1,611
1,801
1,627
2,153
2,624
1,455
1,816
1,285
1,136
2,590
1,121
1,783
46%
28%
45%
56%
44%
52%
56%
44%
n/a
37%
47%
46%
45%
46%
55%
64%
50%
54%
51%
60%
64%
53%
50%
45%
50%
64%
48%
56%
18%
13%
12%
16%
4%
33%
27%
6%
n/a
3%
5%
7%
10%
13%
20%
16%
10%
27%
14%
21%
19%
12%
11%
4%
6%
9%
13%
15%
Source: Avalere Health analysis using DataFrame®, a proprietary database of Medicare Part D plan features. 2008
data from November 2007; 2007 data from November 2006.
*Unweighted **Lives covered by MedicareRx Rewards Value will be shifted to MedicareRx Rewards Standard in 2008.
***Lives covered by WellCare Signature will be shifted to WellCare Classic in 2008.
© Avalere Health LLC
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Texas Plans Gaining LIS Lives in 2008: Smaller Formularies
and More Prior Authorization
2500
2000
15%
15
12
2,075
50%
10%
1,783
9
1500
57%
56%
6%
6
1000
50%
500
0
Plans Losing Dual
Eligibles in 2008 (2007
formulary)
(n = 5)
3
43%
44%
Plans Losing Dual
Eligibles in 2008 (2008
formulary)
Plans Gaining Dual
Eligibles in 2008 (2008
formulary)
(n = 5)
% Drugs with Prior Authorization
# Drugs on Formulary
3000
2,837
Brands
Generics
% PA
0
(n = 13)
Source: Avalere Health analysis using DataFrame®, a proprietary database of Medicare Part D plan features. 2008
data from November 2007; 2007 data from November 2006.
© Avalere Health LLC
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Some Texas Plans Expected to Gain or Lose Over 30,000
LIS Lives in 2008
Plan Name (Texas)
Approximate # LIS Lives
lost/gained (2007-2008)*
Plans Expected to Lose LIS Lives in 2008
Humana PDP Standard
AARP MedicareRx Saver
WellCare Signature
MedicareRx Rewards Value
AARP MedicareRx Preferred
Plans Expected to Gain LIS Lives in 2008
First Health Part D - Premier
Blue Medicare Rx Standard
Health Net Orange Option 2
Health Net Orange Option 1
Scott and White Health Plan Texas Rx Value
SilverScript
CIGNA Medicare Rx Plan One
HealthSpring Prescription Drug Plan
Aetna Medicare Rx Essentials
BravoRx
Community Care Rx Basic
Prescription Pathway Bronze
Advantage Star Plan by Rx America
MedicareRx Rewards Standard
WellCare Classic
Source: Proprietary Avalere Health model; Kaiser Family Foundation reports CMS estimates of how many dual
eligibles were auto-enrolled into PDPs by state as of June 11, 2006 and January 17, 2007
*Enrollment rounded to the nearest thousand; First Health Part D - Premier and Blue Medicare Rx Standard are
exceptions.
-36,000
-31,000
-25,000
-23,000
-10,000
+30
+310
+3,000
+3,000
+6,000
+6,000
+6,000
+6,000
+7,000
+7,000
+7,000
+7,000
+7,000
+30,000
+31,000
© Avalere Health LLC
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