Part D plans ramp up prior authorization

Medicare Part D plans have ramped up restrictions on prescription drugs since 2011, a study published in the March edition of Health Affairs found. 

In 2011, Part D plans excluded 20.4% of compounds from formularies and subjected 11.5% to prior authorization or step therapy. In 2020, plans excluded 30.4% of compounds and placed 14% under prior authorization or step therapy. 

Standalone prescription drug plans excluded more drugs from their formularies than Medicare Advantage plans, the study found. In 2020, standalone part D plans excluded 48.1% of brand-name compounds from formularies, while MA-Part D plans excluded 41%. 

The findings are contrary to the perception that Medicare Advantage plans use more utilization management, the study's authors wrote. 

"Unlike stand-alone plans, MA-PD plans are also responsible for their beneficiaries' medical claims, so if an expensive drug can keep a patient out of the hospital or reduce the need for outpatient care or expensive procedures, MA-PD plans have a stronger financial incentive to provide access to it," the study's authors concluded. 

The study was conducted by researchers at the University of Southern California in Los Angeles. 

Read the full study here.

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