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The Office of the Inspector General for the Department of Health and Human Services released a report recently regarding Part D coverage of prescription drugs used by people dually eligible for Medicare and Medicaid. The June report, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2018, found that most Part D plan formularies include prescription medications commonly used by dual eligible beneficiaries. The report’s findings include:

  • On average, Part D plan formularies include 96 percent of the 197 commonly used drugs (the list of the 200 drugs most commonly used by dual eligible was developed using data from the 2013 Medicare Current Beneficiary Survey – the most recent data available at the time of the study. The drugs most commonly used by dual eligible MCBS survey participants in 2013 account for 88 percent of all prescriptions dispensed to the dual-eligible respondents in the 2013 MCBS).
  • The average rate of inclusion decreased slightly between 2017 and 2018, from 97 percent to 96 percent.
  • 68 percent of the commonly used drugs are included by all Part D plan formularies.
  • The percentage of drugs to which plan formularies applied utilization management tools increased slightly between 2017 and 2018. On average, formularies applied utilization management tools to 29 percent of the unique drugs reviewed in 2018, an increase of 1 percentage point from 2017.
  • There are 386 unique formularies used by Part D plans in 2018. 12 formularies include 100 percent of the commonly used drugs. Two formularies include 85 percent of the commonly used drugs.
  • Of the approximately 10.8 million dual eligibles enrolled in Part D plans nationwide, approximately 93 percent are enrolled in Part D plans with formularies that include at least 90 percent of the commonly used drugs.
  • Seven percent of dual eligibles are enrolled in Part D plans that use formularies that include less than 90 percent of the commonly used drugs.

Access to Medicare Part D prescription drugs for people who are eligible for both Medicare and Medicaid appears to be holding fairly stable.  However, the report cautions that variation in plan formularies, and their use of utilization management might still force beneficiaries to make additional efforts to access the drugs they need, which could result in administrative barriers to accessing certain prescription drugs.

July 26, 2018 – K. Kertesz

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