Identifying Widely Covered Drugs and Drug Coverage Variation Among Medicare Part D Formularies
Published in: JAMA, The Journal of the American Medical Association, v. 297, no. 23, June 20, 2007, p. 2596-2602
Posted on RAND.org on January 01, 2007
Read More
Access further information on this document at jama.ama-assn.orgThis article was published outside of RAND. The full text of the article can be found at the link above.
CONTEXT: Clinicians can find it difficult to know which drugs are covered for their Medicare patients because formularies vary widely among Medicare Part D plans and many states have 50 or more such plans. OBJECTIVE: To determine whether Part D formularies in California (the state with the most Medicare beneficiaries) and Hawaii have at least 1 drug within each of 8 treatment classes for hypertension, hyperlipidemia, and depression that can be identified for clinicians as widely covered by the vast majority of Part D plans. DESIGN AND SETTING: Use of the medicare.gov Web site (March 1-April 15, 2006) to examine 72 California and 43 Hawaii Part D formularies' coverage of 8 treatment classes (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, -blockers, calcium channel blockers, loop diuretics, selective serotonin reuptake inhibitors, statins, and thiazide diuretics), with evaluation of how often drugs were widely covered (defined as inclusion in 90% of formularies at co-payments of $35 without prior authorization). MAIN OUTCOME MEASURE: Identification of treatment classes with at least 1 widely covered drug. RESULTS: For California, coverage for the 75 drugs examined ranged from 7% to 100%. Despite this variation, 7 of 8 classes (excluding angiotensin II receptor blockers) had at least 1 widely covered drug. Of the 34 widely covered drugs (45%), all but 2 were generic. Restricting widely covered to include 95% or more of formularies at co-payments of $15 or less still resulted in 7 of 8 classes with at least 1 widely covered drug. Overall, 73% of generic drugs and 6% of brand-name drugs were widely covered. Findings were similar for Hawaii. CONCLUSIONS: Formularies varied substantially; however, all but 1 treatment class examined had 1 or more widely covered drugs at low co-payments. Knowing which drugs are widely covered would assist clinicians in prescribing, since not all generic drugs were widely covered. Clinicians should know that few brand-name drugs are widely covered and check coverage before prescribing.
This article was published outside of RAND. The full text of the article can be found at the link above.
This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.
Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.