Navigation Links
2014 Medicare Drug Plans Vary Widely in Availability of Drugs and Restrictions on Their Use

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 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 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

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:
(Date:12/1/2015)... Virginia , 1 de diciembre de ... en tecnología para cuchillas de precisión, develó ... programa de identidad de marca. El nuevo ... el diseño y la ingeniería de productos ... la diferencia". ...
(Date:12/1/2015)... 1, 2015 Breg, Inc ., a ... today that it has been awarded three contracts by ... by Novation will have access to improved pricing for ... and soft goods dedicated to advancing orthopedic care.  ... aging U.S. population, rising prevalence of chronic conditions and ...
(Date:12/1/2015)... India , December 1, 2015 ... a new market research report "Nucleic Acid Labeling Market ... (PCR, Nick Translation, Random Primer, In Vitro Transcription, Reverse ... 2020", published by MarketsandMarkets, The global market is expected ... 1,271.8 Million in 2015, growing at a CAGR of ...
Breaking Medicine Technology:
(Date:12/1/2015)... ... December 01, 2015 , ... Royal River Natural Foods ... study that found post-menopausal women who took the nutritional supplement creatine, along with resistance ... trained but did not take creatine. , The report is part of the December ...
(Date:12/1/2015)... ... ... Integrated Rental Services (“Integrated Rental”), a growing medical equipment ... With support from JII, Integrated Rental is poised for expansion while improving its ... labs and medical facilities across the United States. , General Manager Robert Bean ...
(Date:12/1/2015)... , ... December 01, 2015 , ... Florida Hospital Tampa is the first ... obesity in the state of Florida. , vBloc® Therapy is a vagal blocking therapy, delivered ... years with a body mass index (BMI) of at least 40 to 45 kg, or ...
(Date:12/1/2015)... Los Angeles, CA (PRWEB) , ... December 01, 2015 , ... ... a coalition of obesity groups has filed a discrimination claim against the U.S. Department ... surgery coverage in their Affordable Care Act (ACA) plans are breaking the clause in ...
(Date:12/1/2015)... , ... December 01, 2015 , ... ... oncology and hematology continuing medical education (CME), today announced that the first annual ... Hyatt New York. , “The prevention, detection and treatment of gastrointestinal cancers are ...
Breaking Medicine News(10 mins):