Study: Medicare Part D patients struggle more attaining anticonvulsants

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By Mia Burns

New analysis from advisory services company Avalere Health indicates that despite ’ protected class status, prescription drug plans had lower levels of coverage and fewer medicines on less expensive formulary tiers than commercial health insurance plans. This has the potential to impact ’ access to anticonvulsants, which are used in treating epileptic seizures.

The Centers for Medicare & Medicaid Services implemented the protected classes policy to ensure access to “all or substantially all” medicines in six categories of drugs. The risk of poor access to a broad variety of medicines in these six categories substantially increases risk of negative health outcomes. The statute requires prescription drug plans to cover all medicines in these classes, with the exception of multi-source brands of the identical molecular structure, extended release products, products that have the same active ingredient, and dosage forms that do not have a unique route of administration. The statute does not further define what constitutes “protection,” and CMS has sought to balance patient access with the cost of D plans.

“I think that for Medicare Part D patients who are being treated with anticonvulsants that their access generally to drugs in this category is good,” says Kelly Brantley, senior manager at Avalere Health. “It is just not as generous as commercial plans’ brands in that class, but it is very generous for generic products in the same category.”

UCB, Inc. funded the , which measured access to anticonvulsants by each drug’s presence on the formulary, level of cost-sharing, and utilization management techniques. The main takeaways from the analysis are the following: Commercial plans had higher levels of coverage of anticonvulsants on formularies than prescription drug plans, including coverage of brand-name and extended release products; commercial plans placed covered…Read more

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