Managed Healthcare Executive - January 2009 - (Page 9)

NEWS ANALYSIS Part D tiers shuf e more costs on patients for cancer treatment to analysis presented to the Medicare Payment Advisory Committee (MedPAC) last month. Cost-sharing for generic and WASHINGTON, D.C. — Medicare pre- brand drugs also is on the rise, with many scription drug plans (PDPs) are covering PDPs charging $75 copays for non-premost popular drugs on their formularies, ferred brands. PDPs and Medicare Adincluding costly biotech therapies and anti- vantage drug plans seek to control costs cancer treatments. Bene ciaries have to further by increasing the use of prior pay more out-of-pocket, however, for authorization, step therapy and quantity high-cost drugs. limits to manage utilization. PDPs are shifting more costs to enrollees by revising formularies to four BENEFICIARY BURDEN tiers, topped by a specialty tier for bio- The rising coinsurance rates for oral tech therapies that often cost more than cancer drugs translate into high ben$600 a month. Those PDPs with multiple e ciary costs, according to a report by tiers tend to list more products. Avalere Health and the American CanDrugs in specialty tiers carry high co- cer Society Cancer Action Network. insurance rates, up to 33% in 2009 from For example, 84% of PDP enrollees a median 25% three years ago, according are in plans that put leukemia treatment WASHINGTON BURE AU CHIEF JILL WECHSLER Gleevec on tier four or higher, compared to 39% in 2006. The costs vary by drug plan and by state and may be higher if a patient has other health complications. The report nds that Medicare bene ciaries pay up to $2,800 out of pocket for Part D drugs to treat breast cancer. Generic competition has greatly reduced the cost of tamoxifen, but generic alternatives are rare in cancer treatment. Cancer patient advocates are concerned that high costs and increased use of prior authorization can reduce treatment options and limit access to life-saving therapies, particularly when Medicare bene ciaries using these costly medicines fall into the coverage gap. Out-of-pocket costs then can reach to $500 a month for breast cancer treatment. The American Cancer Society and others point to the need to overhaul the system to provide adequate and a ordable coverage. MHE http://www.jacobsononline.com http://www.jacobsononline.com

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - January 2009

Managed Healthcare Executive - January 2009 Contents Editorial Advisors For Your Benefit News Analysis Politics & Policy Letter of the Law Managed Care Outlook New Day 5 New Realities of Disease Management Pharmacy Best Practices Health Management Technology State Report: Hawaii MHE Resource Ad/Edit Index

Managed Healthcare Executive - January 2009

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