Mind the Gap! Consumer Perceptions and Choices of Medicare Part D Prescription Drug Plans

We study whether people became less likely to switch Medicare prescription drug plans (PDPs) due to more options and more time in Part D. Panel data for a random 20 percent sample of enrollees from 2006–2010 show that 50 percent were not in their original PDPs by 2010. Individuals switched PDPs in response to higher costs of their status quo plans, saving them money. Contrary to choice overload, larger choice sets increased switching unless the additional plans were relatively expensive. Neither switching overall nor responsiveness to costs declined over time, and above-minimum spending in 2010 remained below the 2006 and 2007 levels. (JEL H51, I13, I18)

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Biosimilar formulary placement in Medicare Part D prescription drug plans: A case study of infliximab

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa376 ◽

2020 ◽

Author(s):

Mariana P Socal ◽

Ijeamaka Ezebilo ◽

Ge Bai ◽

Gerard F Anderson

Keyword(s):

Prescription Drug ◽

Cost Sharing ◽

Cost Savings ◽

Medicare Part D ◽

Medicare Part ◽

Prior Authorization ◽

Part D ◽

Medicare Program ◽

Prescription Drug Plans ◽

Step Therapy

Abstract Purpose Biosimilars can generate competition and provide cost savings over reference biologics for the Medicare program and beneficiaries. The extent to which these benefits can be realized in the Medicare Part D program depends on how biosimilars and biologics are placed in the formulary. We conducted a study to examine Medicare formulary placement of the first biologic to have 2 biosimilars on the market—infliximab and its biosimilars infliximab-dyyb and infliximab-abda. Methods All standalone and Medicare Advantage (MA) prescription drug plans (PDPs) offered in Medicare Part D were examined between September 2016 (ie, at the end of the last quarter before the launch of the first infliximab biosimilar) and September 2018, at which time a second biosimilar had been on the market for about 14 months. When PDPs covered both the reference biologic and a biosimilar, we compared the cost-sharing tier and the frequency of prior authorization and step therapy requirements for each drug. Results Nearly all PDPs covered infliximab throughout the study period. By September 2018, 31.7% of MA plans and 14.9% of standalone PDPs were covering a biosimilar on the market. Nearly all plans that covered a biosimilar also covered the reference product. Most plans (98% of standalone PDPs and 89% of MA plans) had placed prior authorization restrictions on both the biologic and the biosimilar. All plans covering both products placed them in the same cost-sharing tier. No plan required step therapy for either product. Conclusion Formulary placement of infliximab biologic and biosimilars in Medicare Part D is not optimized to generate cost savings for the Medicare program and beneficiaries, whose cost sharing is often based on the drug’s list price. The Medicare program should provide incentives for PDPs to expand biosimilar coverage.

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