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Part D plans generally include drugs commonly used by dual eligibles: 2020
Part D plans generally include drugs commonly used by dual eligibles: 2020
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- Washington, D.C. : U.S. Department of Health and Human Services, Office of Inspector General, June 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Dual MEDICAID MEDICARE Eligibility
Government Regulation
Medicare Part D -- organization & administration
Pharmaceutical Preparations -- supply & distribution
United States
United States. Department of Health and Human Services - Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. The ACA requires OIG to conduct a study of the extent to which formularies used by Medicare Part D plans include drugs commonly used by full-benefit dual eligible individuals (i.e., individuals who are eligible for both Medicare and full Medicaid benefits). These individuals generally get drug coverage through Medicare Part D. Pursuant to the ACA, OIG must annually issue a report with recommendations as appropriate. This is the tenth report OIG has produced to meet this mandate. How OIG Did This Review. For this report, we determined whether the 448 unique formularies used by the 4,610 Part D plans operating in 2020 cover the 200 drugs most commonly used by dual eligibles. We also determined the extent to which plan formularies applied utilization management tools to those commonly used drugs. To create the list of the 200 drugs most commonly used by dual eligibles, we used data from the 2017 Medicare Current Beneficiary Survey—the most recent data available at the time of our study. Of the top 200 drugs, 195 are eligible for Part D prescription drug coverage, 2 are excluded from coverage, 1 is no longer offered as a prescription, and 1 is a medical supply item covered by Part D. One additional drug is eligible for Part D prescription drug coverage. However, we did not include it in our analysis because we could not confidently project the use of this drug to the entire dual eligible population. What OIG Found. Overall, we found that the rate of Part D plan formularies’ inclusion of the 195 drugs commonly used by dual eligibles (i.e., individuals who are eligible for both Medicare and Medicaid) is high, with some variation. On average, Part D plan formularies include 97 percent of the 195 commonly used drugs. In addition, 75 percent of the commonly used drugs are included by all Part D plan formularies. These results are largely unchanged from the Office of Inspector General’s (OIG’s) findings for formularies reported in the mandated annual report from 2019, as well as from the findings in our reports from 2011 through 2018. We also found that the percentage of drugs to which plan formularies applied utilization management tools increased slightly between 2019 and 2020. On average, formularies applied utilization management tools to 29 percent of the unique drugs we reviewed in 2020, an increase of 1 percentage point from 2019.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (34 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918282077406676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918282077406676