Elderly/Long-term Care

Many seniors will pay double the monthly copay for angiotensin receptor blockers under the Medicare Part D drug plan compared with their previous plans

Under the Medicare Part D prescription drug benefit, individual prescription drug plans (PDPs) must include at least two drugs in each medication class defined by their drug formularies. The inclusion of angiotensin receptor blockers (ARBs) on the formularies of Medicare Part D PDPs is critical to the health of seniors who cannot tolerate angiotensin-converting enzyme (ACE) inhibitors, which are in the same drug category.

These medications are used to treat hypertension and congestive heart failure and to prevent end-stage renal disease. There are no generic ARBs at this time, and brand-name ARBs currently cost four to five times more than generic ACE inhibitors. Seniors without prior drug coverage may save some money on ARBs under Part D after taking into account the Medicare Part D premium they must pay. However, many seniors who previously paid with private insurance will pay twice as much in average monthly copays for ARBs under Part D, concludes a new study. Also, few plans offer any gap coverage for brand-name drugs, so an estimated 46 to 51 percent of seniors will end up paying the full cost of ARBs once they reach the "donut hole," if they do not have gap coverage.

The "donut hole" is the second phase of Part D coverage, when seniors must pay 100 percent of drug costs out of their own pocket. It follows the first phase, when beneficiaries pay a deductible and about 25 percent of drugs costs, and is before the third phase, when they pay about 5 percent of drug costs.

Researchers analyzed formulary information contained on the March 2006 PDP Formulary and Pharmacy network, on the 7 approved ARBS for all 1,446 PDPs in the country. They also analyzed data from the 2002 and 2003 Medical Expenditure Panel Surveys to estimate the number of seniors using ARBs and their associated copays.

ARBs were included on the drug formularies of all 1,446 plans. In 2003, 70 percent of seniors who filled a prescription for an ARB used either valsartan or losartan. The average monthly copay for the most commonly used ARB, valsartan, was $28 under Part D, $14 before Part D for individuals who had prescription drug coverage, and $53 before Part D for individuals without prior coverage. Thus, seniors who paid for their medications completely out-of-pocket (self-pay) before Part D may pay a lower average amount for their ARB if they join a PDP. However, individuals who had supplemental drug coverage and paid between $11.76 and $15.58 for their 30-day supplies of ARBs would pay substantially more under Part D.

The study was supported in part by the Agency for Healthcare Research and Quality (HS10771 and HS10856).

More details are in "Angiotensin receptor blockers on the formularies of Medicare drug plans," by Walid F. Gellad, M.D., Haiden A. Huskamp, Ph.D., Kathryn A. Phillips, Ph.D., and Jennifer S. Haas, M.D., M.S.P.H., in the August 2007 Journal of General Internal Medicine 22, pp. 1172-1175.

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