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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
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SOURCE HealthPocket
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