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

(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, MD, MPH, 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% requiring prior authorization. In 81–100% of plans, patients were required to pay a coinsurance percentage (averaging 29.6% 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 (55–100% vs. 22–100%), but the average coinsurance was higher (31.1 vs. 29.0%). 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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