BOSTON, MA--(Marketwire - May 6, 2008) - A new study by the Tufts Center for the Study of
Drug Development has found that Medicare prescription drug plans that came
into being following the landmark Medicare Modernization Act of 2003 are
not fully compliant with federal regulations governing medications in six
therapeutic categories.
The study determined that formularies offered by Medicare-eligible plans,
on average, include only 83% of 206 drugs approved by the U.S. Food and
Drug Administration across six therapeutic categories, while imposing
conditions of reimbursement on 18% of them. Federal regulations require
that all drugs in the six categories be covered by Medicare plans.
"These formulary restrictions could impair access to medically necessary
pharmaceuticals, but achieving full compliance comes at a price. More
stringent laws requiring coverage of each and every drug in the categories
we looked at would mean higher costs for Medicare beneficiaries," said
Joshua Cohen, senior research fellow at Tufts CSDD and author of the study.
"The Centers for Medicare and Medicaid Services must weigh the advantages
and disadvantages of regulations concerning coverage and conditions of
reimbursement. The more it mandates, the less leverage plans will have to
negotiate favorable prices with drug companies."
A formulary is a list of selected pharmaceuticals and dosages recommended
by health insurers.
Research results of the Tufts CSDD study, reported in the May/June Tufts
CSDD Impact Report, released today, also found that:
-- Medicare beneficiaries receiving anticonvulsants, antidepressants,
antineoplastics, antipsychotics, HIV/AIDS drugs, or immunosuppressants
have some of the highest drug and medical costs among all beneficiaries.
-- Drug plans, on average, pay for 72% of the costs of the drugs they
cover, which violates the CMS guidance requiring coverage of 75% of
the costs of "all or substantially all" drugs in the six therapeutic
categories.
-- Medicare beneficiaries spend an average of $15-$35 per 30-day
prescription out-of-pocket on covered drugs in the six categories, a
figure expected to increase as the number of specialty pharmaceuticals
increases.
About the Tufts Center for the Study of Drug Development
The Tufts Center for the Study of Drug Development (
http://csdd.tufts.edu)
at Tufts University provides strategic information to help drug developers,
regulators, and policy makers improve the quality and efficiency of
pharmaceutical development, review, and utilization. Tufts CSDD, based in
Boston, conducts a wide range of in-depth analyses on pharmaceutical issues
and hosts symposia, workshops, and public forums, and publishes the Tufts
CSDD Impact Report, a bi-monthly newsletter providing analysis and insight
into critical drug development issues.
Contact Information: Contact:
Tufts Center for the Study of Drug Development
Charlene Neu
617-636-2187
Business Communication Strategies
Peter Lowy
617-734-9980