Study Finds Variation in Coverage and Access in Medicare Part D Plans

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<p>Under Medicare Part D, beneficiaries must choose among dozens of prescription drug plans available in each state--each with different benefit designs and formulary structures.<br><br>A new issue brief, <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=23786&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D398836%26%23doc398836">Assessing Medicare Prescription Drug Plans in Four States: Balancing Cost and Access,</a> by Erika Heaton and Tanisha Carino, Ph.D., of Avalere Health, and Heidi Dix, M.P.H., the assistant secretary of health and human resources for the Commonwealth of Virginia, examines Part D plans in the four most populous Medicare states: California, Florida, New York, and Texas. Researchers find wide variation in the total number of drugs covered by individual plans; in how easily enrollees can obtain specific drugs; and in cost-sharing requirements.<br><br>Moreover, the researchers reveal that plans with lower premiums are more likely to include barriers to obtaining specific drugs. With a large number of plans to choose from and detailed information on benefit structure difficult to obtain, some Part D beneficiaries may not discover until after they are enrolled that their medications are not readily accessible, or that they are subject to significant copayments. This may be particularly problematic for the most vulnerable beneficiaries, such as those who were dually eligible for Medicaid and assigned to plans with lower than average premiums.<br><br>The authors recommend that the Centers for Medicare and Medicaid Services monitor enrollees' experiences to determine how well plans are meeting the needs of beneficiaries, particularly the frail and disabled.</p>