New Rheumatoid Arthritis Findings from University of Hawaii Described (Coverage for High-Cost Specialty Drugs for Rheumatoid Arthritis in Medicare…

New Rheumatoid Arthritis Findings from University of Hawaii Described (Coverage for High-Cost Specialty Drugs for Rheumatoid Arthritis in Medicare Part D)

By a News Reporter-Staff News Editor at Insurance Weekly News -- Current study results on Autoimmune Diseases and Disorders have been published. According to news reporting originating in Mililani, Hawaii, by VerticalNews journalists, research stated, "More than 1 in 4 Medicare beneficiaries with rheumatoid arthritis use high-cost biologic disease-modifying antirheumatic drugs (DMARDs), and spending for these drugs has risen sharply for Medicare Part D. Our aim was to conduct the first systematic, national investigation of how Part D plans cover biologic DMARDs and to determine patients' financial burden under current cost-sharing structures. We performed a cross-sectional analysis of Part D plan formularies (n=2,737) in 50 states and Washington, DC using the January 2013 Centers for Medicare and Medicaid Services Prescription Drug Plan Formulary and Pharmacy Network Files."

The news reporters obtained a quote from the research from the University of Hawaii, "We calculated the percentage of plans covering each DMARD as well as the percentage requiring prior authorization and/or coinsurance. We also compared biologic drug coverage in Medicare Advantage prescription drug plans to that in Medicare Part D stand-alone plans. All plans covered at least 1 biologic DMARD, but the vast majority required prior authorizations (95%). Nearly all plans (81-100%) required patients to pay a coinsurance percentage (averaging 29.6% of drug costs) rather than a fixed dollar copayment. This translated into mean out-of-pocket costs of $2,712-$2,774 before reaching the catastrophic phase of coverage, during which beneficiaries pay 5% of drug costs. Medicare Advantage prescription drug plans covered more individual biologic DMARDs (55-100%) than did Medicare Part D stand-alone plans (22-100%), but Medicare Advantage prescription drug plans required higher average coinsurance (31.1% versus 29.0%). In contrast, 6 of 9 nonbiologic DMARDs were covered by nearly all plans without prior authorizations at fixed copayments averaging $5-$10/month."

According to the news reporters, the research concluded: "Nationally, nearly all Part D plans cover at least 1 biologic DMARD, but the vast majority require cost sharing sufficiently high to risk significant financial burden to patients."

For more information on this research see: Coverage for High-Cost Specialty Drugs for Rheumatoid Arthritis in Medicare Part D. Arthritis & Rheumatology, 2015;67(6):1474-1480. Arthritis & Rheumatology can be contacted at: Wiley-Blackwell, 111 River St, Hoboken 07030-5774, NJ, USA.

Our news correspondents report that additional information may be obtained by contacting J. Yazdany, University of Hawaii, John A Burns Sch Med, Mililani, HI, United States. Additional authors for this research include R.A. Dudley, R. Chen, G.A. Lin and C.W. Tseng.

Keywords for this news article include: Hawaii, Mililani, Medicare, Legal Issues, United States, Health Policy, Joint Diseases, Rheumatoid Arthritis, Investment and Finance, Musculoskeletal Diseases, North and Central America, Autoimmune Diseases and Disorders

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