Thursday, March 23, 2006
Medicaid and Medicare
A new
reportMedicaid and Medicare
New Medicare Drug Plans Restrict Access to Important Drugs
released by Rep. Waxman is the first detailed analysis
of the use of restrictive tactics by Medicare drug plans.
Based on a Medicare database, a phone survey of Medicare drug plans conducted in Rep. Waxman's congressional district, and the Medicare.gov website available to seniors, the report finds that the use of prior authorization requirements, step-therapy provisions, and volume limits by the Medicare drug plans is widespread, but disclosure of their terms is virtually nonexistent.
Specifically, the report finds:
- Prior authorization requirements, step-therapy provisions, and volume limits by the vast majority of Medicare drug plans restrict access to formulary drugs. The Medicare data show that 97% of plans place either prior authorization or step therapy requirements on at least one of the 100 most popular drugs, with the average plan restricting access to over 10% of the popular drugs listed in its formulary.
- Medicare drug plans are unable to describe plan restrictions accurately. Over two-thirds of the Medicare drug plans contacted in the phone survey were unable to describe accurately how the prior approval, step therapy, or volume limits worked with their particular plan.
- Medicare drug plans provide erroneous or conflicting information about restrictions. A number of Medicare drug plans provided information that was erroneous or misleading or conflicted with other information provided by the plan in the phone survey.
- The Medicare website and the websites of plan sponsors
fail to provide adequate information about restrictions.
Seniors cannot rely on the Medicare.gov website or
the websites of plan sponsors to inform themselves
about the details of plan restrictions.
Documents and Links
