MANAGED CARE January 2007. ©MediMedia USA
Seventy-five percent of cancer drugs are covered by Medicare Part D plans, with regional MA-PDPs (Medicare Advantage prescription drug plans) covering 85 percent.
Researchers at Avalere Health stratified the universe of cancer drugs covered by each Part D plan by contract type (local MA-PDP, regional MA-PDP, and stand-alone PDP). Prior authorization is the most common cost-limiting tool applied to brand-name cancer drugs, and PDPs and local MA-PDPs use prior authorization more frequently than regional MA-PDDs do. "Plans' use of policies such as prior authorization must be carefully monitored to ensure that cancer patients receive timely and appropriate treatment," says Jennifer Bowman, director and lead researcher of the study.
Cancer drug coverage by Medicare Part D plan types
Source: Bowman J, et al. Health Affairs. 2006;25(5):1240–1248.