Most Part D Plans Cover at Least One Biologic DMARD

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Most Part D Plans Cover at Least One Biologic DMARD
Most Part D Plans Cover at Least One Biologic DMARD

WEDNESDAY, June 3, 2015 (HealthDay News) -- Although most Medicare Part D plans cover at least one biologic disease-modifying antirheumatic drug (DMARD), copayments are high, according to a study published in the June issue of Arthritis & Rheumatology.

Jinoos Yazdany, M.D., M.P.H., from the University of California in San Francisco, and colleagues performed a cross-sectional analysis of 2,737 Part D plan formularies in 50 states and Washington, D.C. The percentage of plans covering each DMARD was calculated, as well as the percentage requiring prior authorization and/or coinsurance.

The researchers found that all plans covered at least one biologic DMARD, with 95 percent requiring prior authorization. In 81 to 100 percent of plans, patients were required to pay a coinsurance percentage (averaging 29.6 percent of drug costs) rather than a fixed copayment; the mean out-of-pocket costs were $2,712 to $2,774 prior to reaching the catastrophic phase of coverage. Medicare Advantage prescription drug plans covered more individual biologic DMARDs than Medicare Part D stand-alone (55 to 100 percent versus 22 to 100 percent), but the average coinsurance was higher (31.1 versus 29.0 percent). Nearly all plans covered six of nine nonbiologic DMARDS without prior authorizations, at fixed copayments averaging $5 to $10 per month.

"Nationally, nearly all Part D plans cover at least one biologic DMARD, but the vast majority require cost sharing sufficiently high to risk significant financial burden to patients," the authors write.

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