Navigation Links
2014 Medicare Drug Plans Vary Widely in Availability of Drugs and Restrictions on Their Use
Date:11/1/2013

SUNNYVALE, Calif., Nov. 1, 2013 /PRNewswire-USNewswire/ -- A new analysis from HealthPocket of recently released data on Medicare drug plans reveals that as compared to 2013, slightly more drugs will be available on average under Medicare stand alone prescription drug plans (PDPs) and fewer on average will be available under the Medicare Advantage prescription drug benefit (MAPD). The variation in the number of available drugs is significant: MAPD plans range from 956 to 2334, and PDP plans range from 995 to 2333. On average, MAPD plans will include 1492 drugs on plan formularies, and PDP plans will include 1456.

An estimated 90 percent of Medicare enrollees have some form of drug benefit, affecting about 45 million Americans. As is true in the private health insurance market, each Medicare plan has a "formulary" that lists out which drugs are covered and what out-of- pocket costs a consumer is responsible for in a given year for those medications. If a consumer is on a drug that does not appear on the plan formulary, he or she will have to pay the full cost. Yet even if a drug is on the formulary, plans can restrict access to it through various mechanisms, including limiting the quantity; requiring prior authorization; and mandating a step therapy process for certain medications.

MAPD plans in 2014 will carry quantity limits on 0 to 32 percent of drugs, prior authorization on 3 to 37 percent and step therapy on 0 to 11 percent. PDP plans will have quantity limits on 1 to 31 percent of drugs, prior authorization on 7 to 32 percent and step therapy on 0 to 9 percent. Kaiser's MAPD plan offers a high number of drugs, with 2320 drugs on its formulary, approaching the industry maximum of 2333. None of the drugs on its formulary carries quantity limits or step therapy restrictions, and prior authorization is required for only 3 percent of all drugs offered.

"The lesson here for Medicare patients is that they really need to do their homework during open enrollment season to figure out which plans give them the best deal," said Steve Zaleznick, executive director for Consumer Strategy and Development at HealthPocket. "The most important question for consumers is if the drugs they take are on the plan's formulary, and the next is what hoops they may have to jump through to actually get the drugs in hand."

This HealthPocket InfoStat is part of a series using health plan data to produce unbiased market analysis and guidance for consumers navigating America's changing health insurance environment. Consumers can review Medicare plan options for free using HealthPocket's Medicare comparison tool.   

About HealthPocket

HealthPocket.com is a free website that compares and ranks all health plans available to an individual, family, or small business, so everyone can make their best health plan decision and save on their out-of-pocket costs. The Company uses only objective data from government, nonprofit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource. The founders of HealthPocket.com spent decades pioneering online access to health insurance information and knew they could offer something different that can positively change how people buy and use healthcare in the U.S. Learn more at www.HealthPocket.com.


'/>"/>
SOURCE HealthPocket
Copyright©2012 PR Newswire.
All rights reserved

Related medicine technology :

1. PCMA Supports Bipartisan Legislation Creating Safe Pharmacy Networks to Reduce Prescription Drug Abuse in Medicare
2. Blue Cross Blue Shield of Arizona Advantage Adds Scottsdale Healthcare to Medicare Advantage Network
3. Medicare Procurement Program Creates Extreme Hardships For North Carolina Patients, Says AAHomecare
4. Medicare Procurement Program Creates Extreme Hardships for Patients without Options, Says AAHomecare
5. PCMA: Eight Ways to Reduce Federal Health Spending and Improve Prescription Drug Benefits in Medicare and Medicaid
6. New Research Finds Many Seniors Wrongly Think Public Health Insurance Exchanges Are Replacing Medicare Plans
7. Breakthrough AffloVest now reimbursed by Medicare and private health insurance
8. Express Scripts Acquires SmartD Medicare Prescription Drug Plan; Adds to Industry-Leading Medicare Offering
9. NxStage Urges CMS to Fix Training Reimbursement to Provide Medicare Patients Greater Access to Life-Changing Home Hemodialysis Therapies
10. Piramal Imaging Provides Comments in Response to the Centers for Medicare and Medicaid Services (CMS) Proposed Coverage Decision for Beta-Amyloid Positron Emission Tomography (PET)
11. From Encision Inc.: New Medicare Penalties to Include Laparoscopic Complications
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... 24, 2016 According to a ... (Standard Pen Needles, Safety Pen Needles), Needle Length (4mm, ... Hormone), Mode of Purchase (Retail, Non-Retail) - Trends & ... studies the market for the forecast period of 2016 ... 2.81 Billion by 2021 from USD 1.65 Billion in ...
(Date:6/24/2016)... June 24, 2016  Arkis BioSciences, a leading ... and more durable cerebrospinal fluid treatments, today announced ... Series-A funding is led by Innova Memphis, followed ... other private investors.  Arkis, new financing will accelerate ... the market release of its in-licensed Endexo® technology. ...
(Date:6/23/2016)... 23, 2016 Any dentist who has made an ... current process. Many of them do not even offer this ... and high laboratory costs involved. And those who ARE able ... such a high cost that the majority of today,s patients ... Parsa Zadeh , founder of Dental Evolutions Inc. and ...
Breaking Medicine Technology:
(Date:6/24/2016)... ... June 24, 2016 , ... The Pulmonary Hypertension ... that it will receive two significant new grants to support its work to ... its 25th anniversary by recognizing patients, medical professionals and scientists for their work ...
(Date:6/24/2016)... ... June 24, 2016 , ... Dr. Amanda Cheng, ... treatment. Dr. Cheng has extensive experience with all areas of orthodontics, including robotic ... osteogenic orthodontics. , Micro-osteoperforation is a revolutionary adjunct to orthodontic treatment. It ...
(Date:6/24/2016)... ... 24, 2016 , ... Topical BioMedics, Inc, makers of Topricin and MyPainAway Pain Relief Products, join ... wage raise to $12 an hour by 2020 and then adjusting it yearly to increase ... of the minimum wage, assure the wage floor does not erode again, and make future ...
(Date:6/24/2016)... Georgia (PRWEB) , ... June 24, 2016 , ... ... awards today at the Clinical Decision Making in Emergency Medicine conference in Ponte ... have authored journal articles published in Emergency Medicine Practice and Pediatric ...
(Date:6/24/2016)... ... June 24, 2016 , ... Puradigm® & Innovative ... has initiated cultivation and processing operations at its production facility, and opened its ... Puradigm is the manufacturer of a complete system of proactive air and surface ...
Breaking Medicine News(10 mins):