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Medicare Drug Plans Are Onerous and Restrictive

saying AdvantraRx: Medicare prescription drug plans made easy. But then he said that each drug has a unique clinical criterion that must be met. Hence these forms serve as a checklist of necessary information which is needed for the company’s review. He also said that prior authorization limits the use of certain drugs like OxyContin and Accutane. In addition, this would prevent the overuse of high-cost medications and to ensure that equally effective, less expensive agents are used first.

The prior authorization forms requires the doctors to provide details of laboratory test results, all office notes and other data to show why certain drugs are needed.

But Dr. Lyons said that it would be desirable to simplify and standardize the prior authorization process.

Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services said that the program was working smoothly for the vast majority of the beneficiaries and that he would look into all the other problems. He also said that there were improvements on a daily basis.

Officials reported that the health plans have been encouraging and the growth of prescription drug spending slowed to 8.2 % in 2004, after nine years of double-digit increases.

John Feather, executive director of the American Society of Consultant Pharmacists said that the use of prior authorization is far more prevalent in Medicare than in commercial insurance programs. Dr. Charles A. Crecelius, a geriatrician in St. Louis, said that the drug plans say they cover more than 90 of the 100 drugs but did not do so. This is due to the reason that the drug may be on the formulary but difficult to obtain because of the prior authorization and other rules.


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