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:7/13/2017)... -- New York City-based market research firm Kalorama Information notes seven ... From new products to new costs, to the threat of ... study, Potential Pipeline Disruptors . Among them ... 1.  Age-Driven Growth - True Impact Moment Arriving   ... the growing population and, to a more extreme extent, the ...
(Date:7/11/2017)... , July 11, 2017  Bayer has awarded grants ... countries as part of its prestigious Bayer Hemophilia Awards Program ... of Philadelphia and Uniformed Services University ... are among the winners. Grant recipients were announced last night ... Hemostasis (ISTH) 2017 Congress, Berlin, Germany . ...
(Date:7/11/2017)... 11, 2017 Oramed Pharmaceuticals Inc. (NASDAQ: ... company focused on the development of oral drug delivery ... Administration (FDA) has agreed to schedule an End-of-Phase II ... trial of its oral insulin capsule ORMD-0801 in the ... met primary and secondary endpoints by indicating a statistically ...
Breaking Medicine Technology:
(Date:7/24/2017)... ... 2017 , ... The Topricin Companies, formerly Topical Biomedics, is ... natural, after-burn skin care product, Topricin After Burn Cream. , Overexposure ... conditions, including cancer. In the short term, overexposure to sun, wind and ...
(Date:7/24/2017)... Beach, California (PRWEB) , ... July 24, 2017 ... ... commercialization of autologous fat (adipose) transfer systems announces the issuance of United States ... ‘324 patent) for its adipose filtration technology. The '398 and '324 patents ...
(Date:7/24/2017)... ... July 24, 2017 , ... Sharon Kleyne, host of the ... Health on VoiceAmerica sponsored by Nature’s Tears® EyeMist® recently talked on the air about ... in China. , The article by Zidor Aldama described the situation in which Chinese ...
(Date:7/24/2017)... ... July 24, 2017 , ... A Southern California-based author has released a ... and how she has overcome them. “Forbidden Memories: A Memoir,” by author Michelle V. ... she has risen above. , In “Memories,” readers get a firsthand look at what ...
(Date:7/24/2017)... Huntingdon Valley, PA (PRWEB) , ... July 24, 2017 , ... ... wind and rain storms wreak havoc across communities and often result in massive tree ... Top 3 actions homeowners can take now including tree trimming, tree cabling and hazardous ...
Breaking Medicine News(10 mins):