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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 Developm
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SOURCE HealthPocket
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