Medicare Part D Plans Expanding Five-Tier Formularies, Preferred Networks In 2013
This article was originally published in The Pink Sheet Daily
A review of Part D plan design trends among the leading sponsors shows that Humana has switched to five-tier formularies, UnitedHealth is using a preferred pharmacy network and CVS Caremark is sponsoring plans that include community-based independents in its preferred network.
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As Part D open enrollment kicked off Oct. 15, a Kaiser Family Foundation found almost 90% of national and near-national plans use five-tier formularies. And more plans are asking patients to shoulder a higher share of brand drug costs through coinsurance rather than a flat copay.
The evolution of the Medicare Part D marketplace has made features that were virtually unknown at the start of the program into prominent parts of plan designs across the country, according to an analysis by the Kaiser Family Foundation.
The Medicare Payment Advisory Commission expressed concerns about the impact on access to medications that a growing trend for Medicare Part D plan sponsors to use preferred pharmacy networks might have, particularly in rural areas where a preferred pharmacy might be many miles away.