Navigation Links
Medicare Drug Coverage Doesn't Assure Easy Access to Medications
Date:8/8/2013

SUNNYVALE, Calif., Aug. 8, 2013 /PRNewswire-USNewswire/ -- A new analysis from HealthPocket of Medicare drug plans reveals that in both traditional Medicare and Medicare Advantage plans, consumers face various hurdles in accessing their medications. In assessing the highest number of drugs covered with the fewest barriers to getting them, wide variations were seen among plans, with some having more than twice the number of drugs covered as others. On average, 16 percent of drugs within a plan had limitations on the quantity allowed to be purchased at one time; 18 percent of drugs required the health care provider to contact the plan to get prior authorization; and nearly 2 percent required "step therapy" where a less expensive medication must be tried first.   

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.

"Annual enrollment is coming up in October, and that's when consumers have an opportunity to compare health plans on important factors, including drug coverage," said Steve Zaleznick, executive director for Consumer Strategy and Development at HealthPocket. "The first step for Medicare enrollees and all consumers is to ensure that the drugs they take are on the plan's formulary, and the second is to look at what restrictions they may face in actually getting the medication in hand."

While many plans engage in these cost-cutting measures, Kaiser plans had no quantity limits, no step therapy rules and only 3.5 percent of its drugs were subject to prior authorization. As new and reformed Medicare and private plans come online through the Affordable Care Act, this model may prove useful to industry and government alike as the health care system seeks to improve quality, save costs and provide positive consumer experiences.

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. More information about out-of-pocket costs and Medicare plans can be found at www.HealthPocket.com.   

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. Failure to Take Medicine Linked to Unnecessary Hospital Visits, Especially for Medicare Patients Taking High Blood Pressure or High Cholesterol Medications
2. Problems Plague Medicares Method for Measuring Payment Errors
3. Effectiveness of Medicare Authorization Program for Power Wheelchairs Rests on Inclusion of a Clinical Template
4. ApolloMed ACO Selected To Participate In A Transformative New Initiative Sponsored by the Centers for Medicare and Medicaid Services
5. Physician Details Problems with Medicare Approval Process for Power Wheelchairs
6. New Study Answers CMS/USPSTF Concerns for CT Colonography Screening Reimbursement: It is a Viable Option for the Medicare-Aged Population
7. AllMobilityScooters.com Simplifies Medicare
8. Disability Advocates Tell Medicare: Use a Clinical Template to Accurately Document Medical Need for Wheelchairs
9. Center for Medicare & Medicaid Innovation Awards $19 Million Grant to Develop Oncology Medical Home Model
10. PCMA: Part D Plans and PBMs Continue to Deliver Savings in Medicare
11. Homecare Community Dismayed that Medicare Will Start Prior Authorization for Wheelchairs without a Clinical Template for Physicians to Document Need
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:9/28/2017)... Sept. 28, 2017 Cohen Veterans Bioscience and ... use of wearable and home sensors for real-time monitoring ... Signal Foundation, a nonprofit organization focused on disruptive health ... an affordable analytical system to record and integrate behavioral, ... ...
(Date:9/23/2017)... 2017 Janssen Biotech, Inc. (Janssen) announced today ... the U.S. Food and Drug Administration (FDA) for the ... the treatment of moderately to severely active rheumatoid arthritis ... are needed to further evaluate the safety of sirukumab ... "We are ...
(Date:9/18/2017)... KALAMAZOO, Mich. , Sept. 18, 2017  PMD ... OptiMed Specialty Pharmacy of Kalamazoo, Mich. ... strategic hub service that expedites and streamlines patient and ... Spiro PD 2.0, and wellness management services.  ... medical device used to measure lung function for a ...
Breaking Medicine Technology:
(Date:10/13/2017)... ... October 13, 2017 , ... Talented host, actor ... on sciatica in a new episode of "Success Files," which is an award-winning ... innovation and investigates each subject in-depth with passion and integrity. , Sciatica occurs ...
(Date:10/13/2017)... ... October 13, 2017 , ... “The Journey: From the ... danger possible to save lost souls in the Philippines. “The Journey: From the Mountains ... a dedicated teacher of the Bible. She has taught all ages and currently teaches ...
(Date:10/12/2017)... ... October 12, 2017 , ... First Healthcare Compliance (FHC), an ... showcase a range of technology and learning solutions at the 68th Annual American ... to be held October 14–18, 2017 at the Mandalay Bay Resort in Las ...
(Date:10/12/2017)... ... 2017 , ... Planet Fitness, one of the largest and fastest growing franchisors ... a flagship location in Covington, LA at 401 N. U.S. Highway 190, in January ... Office Depot in the Holiday Square shopping center. Its location allows it to serve ...
(Date:10/12/2017)... ... October 12, 2017 , ... IsoComforter, Inc. ( https://isocomforter.com ), ... of an innovative new design of the shoulder pad. The shoulder pad provides ... while controlling your pain while using cold therapy. By utilizing ice and water that ...
Breaking Medicine News(10 mins):