Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Health Insurance > Health Insurance

GAO: Most Medicare Part D Drug List Changes Helped Enrollees

Your article was successfully shared with the contacts you provided.

Most of the Medicare Part D prescription plan drug list changes that insurers made in the middle of 2008 and 2009 expanded enrollees’ access to drugs, according to the U.S. Government Accountability Office (GAO).

Medicare Part D gives private insurers a vehicle for selling prescription coverage to Medicare enrollees.

The GAO looked at the Part D plans’ mid-year changes to drug lists, or “formularies,” in response to a request from House Democrats.

In 2008, mid-year formulary changes had the potential to reduce access to drugsfor just 4.9% of enrollees who filled a prescription for a drug that year, Kathleen King, a GAO director, writes in a report summarizing the GAO’s mid-year Part D formulary change review.

In those cases, the plan providers, or “sponsors,” removed a drug from a formulary or tightened utilization management requirements.

But the percentage of enrollees who lost access to a drug was probably lower than 4.9%, because Part D program rules often require plans to let enrollees who are already on a drug continue to take the drug when the formulary changes, King says.

All but 4 of the 4,238 Part D plans in existence in 2008 made 2 or more mid-year formulary changes in 2008, and all but 5 of the 4,207 plans in existence in 2009 made 2 or mid-year change in 2009.

The percentage of plans making 100 or more mid-year formulary changes increased to 60% in 2009, from 47% in 2008.

The percentage of the changes that involved adding a drug to a formulary or easing utilization management requirements increased to 89% in 2009, from 87% in 2007, King says.

Other Medicare Part D prescription drug coverage from National Underwriter Life & Health:


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.