Avalere Study Shows Patients with Medicare Part D Have More Difficulty Getting Anticonvulsant Therapy

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with D Have Than Those Commercially Insured

Washington, D.C. – According to a new Avalere analysis, in spite of anticonvulsants’ protected class status, Medicare prescription drug plans (PDPs) had lower levels of coverage and fewer medicines on less expensive formulary tiers than commercial health insurance plans, potentially impacting patients’ access to anticonvulsants – which are used in treating epileptic seizures.

“Our study found that Medicare Part D plans cover fewer anticonvulsant drugs than commercial insurance plans, despite being in a protected class,” said Kelly Brantley of Avalere Health. “The higher cost-sharing seen in the Medicare plans may also serve as a barrier to patient access—a factor not specifically governed by the law.”

The Centers for Medicare & Medicaid Services (CMS) 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 PDPs 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 Part D plans.

This analysis measured access to anticonvulsants by each drug’s presence on the formulary, level of cost-sharing, and utilization management techniques. Overall, the Avalere study concluded that:

 

•         Commercial plans had higher levels of coverage of anticonvulsants on formularies than PDPs, including more coverage of brand-name and extended…Read more

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