Medicare Rx Plans To Cover Fewer Medications Next Year

Main Category: Medicare / Medicaid / SCHIP
Article Date: 05 Dec 2007 - 5:00 PDT

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The number of medications covered under Medicare prescription drug plans offered by the 10 health insurers with the largest enrollment will decrease next year by 26%, according to a recent analysis by Avalere Health, USA Today reports. According to the analysis, the number of medications covered under Medicare prescription drug plans offered by UnitedHealth and Humana next year will decrease by 30%, from more than 3,750 treatments to more than 2,620, although the plans will continue to have some of the largest formularies available.

The decrease in the number of medications covered under Medicare prescription drug plans will occur "mainly because of changes made by Medicare," which no longer will reimburse plans for treatments that FDA has removed from the market, are considered less than effective, have duplicative billing codes or are no longer manufactured, USA Today reports. CMS officials and health insurers maintain that the decrease likely will not affect Medicare beneficiaries who take medications no longer covered by prescription drug plans because they will have access to alternative treatments and can use an appeals process to seek continued coverage of their current treatments. Humana spokesperson Tom Noland said, "As the Part D program develops, the size of the formulary is becoming more aligned with utilization patterns, consumer preferences, health outcomes and value for consumers" (Appleby, USA Today, 12/4).

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