2015 Part D Formularies: Fewer Rxs, Higher Cost-Sharing, More Tiers
A recent analysis by Avalere Health, a health care research and advisory firm, shows several significant changes to Medicare Part D formularies that will affect the way beneficiaries pay for their medications in 2015. Significant changes include:
Fewer drugs covered—Nine out of the top 10 prescription drug plans (PDPs) will cover a smaller portion of total Part D drugs in 2015 compared to 2014. The percentage will range from 50% to 68%.
Greater cost-sharing—Two-thirds of stand-alone Part D PDPs will apply co-insurance, meaning consumers will pay a percentage of the total cost of the drugs, most likely applicable to brand name products.
Four tiers the norm—All Part D plans will have four or more tiers, a notable first since the inception of the Part D program in 2006.
For the first time a specialty tier in all PDPs–Plans can only place a drug on the specialty tier if the total drug price negotiated between the plan and pharmacies exceeds $600 month. Co-insurance will be limited to 25% to 33%, depending on the size of the deductible for a given plan. Unlike drugs placed on all other tiers, beneficiaries cannot appeal the cost sharing for drugs placed on the specialty tier.
Filed under: General Problems
I have no idea what options to pick for medicare this year. I can’t make heads or tails of this and I have no idea what options give me the coverage I need.
Dilaudid has the same issues. I wondered why Methadone was making a sudden comeback a few years ago. This is a bad trend where the mindset of whatever is cheapest is best when its not.
Chronic pain patients everywhere, get ready for the cheapest drug around:
http://painkills2.wordpress.com/2014/11/20/12102011-state-pushes-prescription-painkiller-methadone-saving-millions-but-costing-lives/
“Most painkillers, such as OxyContin, dissipate from the body within hours. Methadone can linger for days, pooling to a toxic reservoir that depresses the respiratory system. With little warning, patients fall asleep and don’t wake up. Doctors call it the silent death.”