Managed Care - March 2009 - (Page 43) THE FORMULARY FILES Part D plans embrace specialty drug tiers edical and pharmacy directors at Medicare Part D plans seem more inclined to create a separate specialty drug tier in their formulary design than their commercial counterparts. Novartis’s Facts, Figures, & Forecasts, 2008–2009, reports that directors were asked to segment their enrollment by tiered copayment design options. Three fourths of the Medicare Advantage-Part D (MA-PDs) plans and stand-alone prescription drug plans (PDPs) had created a specialty tier in 2007, had introduced a specialty tier in 2008, or were planning to introduce a specialty tier in 2009. Only 43 percent of commercial health plans re- M ported having specialty tiers during that time. Also reported were the types of drugs covered in the specialty drug tier. Most injectables were covered. Fewer plans covered oral oncologic agents and other oral agents on a specialty tier. A number of these plans also designated drugs for the specialty tier based on member-cost threshold. Drugs with member costs starting as low as $500 per prescription, per month, or per claim were put on the specialty tier. A $600 member-cost threshold was most frequently reported by these plans. The most common copayments for specialty tiers ranged between $25 and $250. PDP Commercial/group I Added in 2007 I Introduced in 2008 MA-PDP* I Planned for 2009 Percentage of plans implementing a specialty drug tier 26.1% 4.3% 13.0% 4.5% 13.6% 63.6% 8.3% 66.7% Percentage of plans that have drug class in specialty tiers 30% Infused 90% Self-injected 70% Oral oncologic agents 60% Other oral agents 30% Higher cost drugs at or above a member-cost threshold Self-injected 61.1% Oral oncologic agents 55.6% Other oral agents 61.1% Higher cost drugs at or above a member-cost threshold Infused 94.4% Self-injected 44.4% Oral oncologic agents 44.4% Other oral agents 55.6% Higher cost drugs at or above a member-cost threshold 38.9% Infused 77.8% 33.3% *Medicare Advantage prescription drug plan Source: Novartis Pharmacy Benefit Report. Facts, Figures, & Forecasts, 2008-2009. MARCH 2009 / MANAGED CARE 43
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