RESEARCH - For expensive arthritis drugs, Part D plans shift cost to patients and medicare

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For Pricey Arthritis Drugs, Part D Plans Shift Costs to Patients and Medicare

NEW YORK (Reuters Health) Jul 09 - When Medicare patients with

rheumatoid arthritis require biologic disease-modifying antirheumatic

drugs (DMARDs), Part D prescription drug plans will generally shift

most costs onto the beneficiary or Medicare.

As researcher M. Polinski of Brigham and Women's Hospital in

Boston explained to Reuters Health, Medicare itself does not sponsor

any Part D plans. There are two basic sources for Part D coverage, she

noted: so-called Medicare Advantage plans, which are purchased

directly from insurance companies (often as part of a Medicare HMO or

PPO plan), and stand-alone plans, such as those offered by a former

employer or union.

To analyze the impact of various Part D cost-sharing structures,

Polinski and her colleagues followed nearly 15,000 low-income patients

with rheumatoid arthritis as they transitioned from the Medicare

Replacement Drug Demonstration (MRDD) program in 2005 to Medicare Part

D in 2006. The researchers compared the options chosen by the patients

and simulated their out-of-pocket costs under several scenarios.

According to their report in the June 15 issue of Arthritis &

Rheumatism, 81% of the patients enrolled in part D -- a rate roughly

56% higher than for the entire population of patients in the MRDD

program.

Compared to stand-alone plans, the Medicare Advantage plans " had lower

deductibles, lower premiums, and fewer prior authorization, step

therapy, and quantity limit restrictions, " the authors found.

Even so, they report, " Out-of-pocket costs exceeded $4,000 annually in

all cost-sharing scenarios. "

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Read the full article here:

http://www.medscape.com/viewarticle/705642

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