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MS drugs in Medicare Part D: Higher tiers, less coverage, more prior authorizations


 

REPORTING FROM AAN 2018

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LOS ANGELES – Under Medicare Part D, private prescription drug plans and those bundled with Medicare Advantage plans have steadily raised injectable and oral disease-modifying therapies for multiple sclerosis to higher tiers with higher cost sharing, reduced coverage of particular drugs, and increased prior authorizations during the 10-year period of 2007-2016, according to an analysis conducted by Oregon State University researchers.

At the annual meeting of the American Academy of Neurology, Daniel Hartung, PharmD, of Oregon Health and Science University, Portland, and his colleagues reported that the proportion of plans with disease-modifying therapies (DMTs) in the highest tiers, generally tier 5 and above, rose from 11% in 2007 to 95% in 2016.

The scope of drugs covered by the plans declined marginally. Over the 10-year period, plans covering at least three DMTs declined from 98% to 95%, but plans that covered interferon beta-1b, intramuscular or subcutaneous interferon beta-1a, or glatiramer acetate declined from 85%-100% of plans to 60%-81%.

Plans with prior authorizations for DMTs rose across the board. The percentage of plans with at least one DMT not needing prior authorization dropped from 40% to 27%, while plans that covered interferon beta-1b, intramuscular or subcutaneous interferon beta-1a, or glatiramer acetate rose from 62%-65% to 77%-80%.

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