Avalere Health News
Avalere Health Data Finds Four-Tier System Growing Among Medicare Part D Plans
Consumers traditionally pay fixed amounts, or co-pays, when purchasing prescription drugs, and these co-pays are typically lumped into three groups: generics, preferred brands, and non-preferred brands. However, Medicare Part D drug plans have revolutionized the shape of the market by placing more expensive drugs into additional tiers. According to Avalere, 86% of all Medicare Part D plans use four (and sometimes five) tier plan structures, versus only 10% of commercial health plans.
"Health plans are trying to balance competing demands of access to medications and low cost, but the result is that patients with serious illnesses are paying more," said
Using its proprietary DataFrame database, which houses information about every Medicare drug plans' drug coverage and associated benefits, found that on average, Medicare Part D beneficiaries pay 25 percent to 35 percent of the cost of Tier 4 drugs compared with commercial plan beneficiaries who pay a fixed fee of about
"People with cancer, multiple sclerosis, hepatitis C, rheumatoid arthritis, and anemia should be paying very close attention to tiering in Medicare," said Mendelson.
Other facts released by Avalere: — Among Medicare's top 10 Part D plans, 9 use Tier 4 formularies; — The average co-payment for 4th Tier drugs in the Medicare community is $70; — The average co-payment for 3rd Tier or non-preferred drugs in the Medicare community is $40; — Medicare patients generally pay about $20 for preferred prescriptions, and $10 for generic drugs.
For graphics you can use for media stories, please contact
SOURCE Avalere Health
Search Our News Using Google Search
Can't find what you want? Try using Google:
