Part D plans adding specialty drug tier, coinsurance


All Medicare Advantage Part D prescription drug plans next year will be adding a new specialty tier, according to a new analysis from Avalere Health.

The analysis also found that about 66 percent of Part D prescription drug plans will require consumers to pay a coinsurance to at least their top two formulary tiers. That's an increase of 83 percent from 2014.

"Adding coinsurance to a second plan tier means that more beneficiaries will be looking at the full cost of branded drugs at the pharmacy counter," Avalere Health CEO Dan Mendelson said in the analysis. "This strategy has proven central to plan operations as they try to keep premiums low to maintain stability in Part D."

The move also helps insurers decrease the amount of money they spend for high-cost drugs, but Avalere Health's senior manager, Christine Harhaj, said that applying coinsurance could significantly raise the cost sharing for a large proportion of consumers.

Enrollment in the prescription drug plans has grown 3.8 percent year over year, FierceHealthPayer previously reported, so it will be interesting to see whether the increased out-of-pocket costs will thwart this trend.

Specialty tiers already are more popular in Medicare Part D than employer-sponsored insurance plans. And they're becoming even more common, increasing almost 15 percent in the last four years, according to the analysis. 

That popularity could bleed over to other markets. "The clear trend toward specialty tiers in exchanges and Part D is likely to have an impact on employer-sponsored benefit designs over time," Avalere Health Vice President Caroline Pearson said. "Benefit managers and C-Suite executives are definitely taking notice of how active management of the pharmacy benefit may be able to reduce premiums."

To learn more:
- read the Avalere Health analysis

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