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Prescription Drug Benefits for Medicare
Patients with Cancer to cost more in 2009
WASHINGTON, Dec. 12 /PRNewswire-USNewswire/
-- People with cancer enrolled in Medicare
Part D plans will spend more out-of-pocket
for their Part D drugs and face increased
restrictions on access to them in 2009,
according to new research released by
Avalere Health and the American Cancer
Society Cancer Action Network (ACS CAN).
The Avalere-ACS CAN research found that
Medicare stand-alone prescription drug plans
(PDPs) have been increasingly shifting
name-brand oral cancer drugs to higher
formulary tiers over the last four years,
meaning that with each year, the products
have cost more for consumers.
In 2009, the large majority of PDPs placed
name-brand oral oncology products --
including Gleevec, Sutent, Tarceva, Thalomid,
and Tykerb -- on specialty tiers that
require cost sharing of 26 percent to 35
percent for each prescription.
For example, 84 percent of PDP enrollees are
in plans that put Gleevec -- a name-brand
drug used to treat leukemia and other forms
of cancer -- on their most expensive tiers
(fourth or higher) in 2009, up from 39
percent in 2006.
"This pattern of shifting the costs of
branded medications to patients needs to be
scrutinized, especially in light of the
economic difficulty being experienced by so
many seniors," said Valerie Barton, a vice
president at Avalere Health.
"Shifts in drug coverage can limit access to
treatment for people with cancer,
significantly reducing their treatment
options or even requiring a stoppage of
treatment," said Daniel E. Smith, president
of ACS CAN.
"We urge policymakers to pay close attention
to how these changes impact people with
cancer. At the same time, it is critical
that people with cancer understand their
health coverage and the potential hurdles
that may impact their treatment."
In addition to changing tier placement, PDPs
in 2009 are increasing their use of prior
authorization to control access to branded
cancer drugs.
The Avalere-ACS CAN research found that
Gleevec had the largest increase in the
number of PDPs requiring prior
authorization, with 70 percent of plans
requiring it, up from 35 percent in 2006.
Tarceva had the next highest increase, with
62 percent of plans requiring prior
authorization in 2009, up from 35 percent in
2006.
Thalomid was next, with 68 percent of plans
requiring prior authorization in 2009, up
from 43 percent in 2006.
Geography and plan choice influence how much
a person with cancer will spend
out-of-pocket in Medicare Part D. Avalere
and ACS CAN modeled hypothetical drug
regimens for women with breast cancer and
found that total out-of-pocket costs for a
woman enrolled in AARP MedicareRx Saver in
Florida will be about $1,985, while total
out-of-pocket costs for beneficiaries
enrolled in Humana PDP Standard in
California will average about $2,551.
ACS CAN and the American Cancer Society are
closely monitoring these issues as part of
their nationwide efforts to ensure access to
quality, affordable health care for all
Americans.
The organizations believe that the health
care system needs to be retooled with an
emphasis on prevention and early detection;
meaningful health insurance that is
adequate, affordable, available and
administratively simple; and reducing pain
and suffering with an emphasis on quality of
life.
Avalere continues to analyze Medicare drug
benefit data. Since the inception of the
Medicare drug program, Avalere has used its
proprietary DataFrame(R) database to track
trends in drug pricing, plan strategy and
structure, and the beneficiary experience.
ACS CAN, the nonprofit, nonpartisan advocacy
affiliate of the American Cancer Society,
supports evidence-based policy and
legislative solutions designed to eliminate
cancer as a major health problem.
ACS CAN works to encourage elected officials
and candidates to make cancer a top national
priority. ACS CAN gives ordinary people
extraordinary power to fight cancer with the
training and tools they need to make their
voices heard. For more information, visit
http://www.acscan.org/ .
Avalere Health is a leading advisory company
focused on business strategy and public
policy. It serves a diverse client base,
which includes Fortune 500 healthcare
technology companies, federal government
agencies, and major medical foundations.
The company is organized into seven
substantive areas -- Medicare, Medicaid,
Reimbursement, Long-Term and Post-Acute
Care, Health Information Exchange,
Evidence-Based Medicine, and Education.
Anchored by a comprehensive research engine
and staffed by experts in business, medical
product commercialization, and health
policy, Avalere provides strategic guidance,
objective analytic research, and quality
educational programs focused on the full
range of healthcare issues facing our
nation. Further information can be obtained
at
http://www.avalerehealth.net/.
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