The vast majority of Part D plans follow a tiered cost-sharing structure with incentives for members to use less expensive generic and preferred brand-name drugs. Cost-sharing has increased since 2006, but the Kaiser Family Foundation reports in “Analysis of Medicare Prescription Drug Plans in 2011 and Key Trends Since 2006” that there was barely a change between 2010 and 2011.” The foundation reports that since 2006, median cost sharing for a 30-day supply of nonpreferred brand name drugs in stand-alone prescription drug plans (PDPs) increased by 42 percent, from $55 to $78. Preferred brand costs increased 50 percent, from $28 to $42. But since 2010, cost sharing has been stable.
About half of PDP enrollees and over 75 percent of MA-PD plan enrollees are in plans that charge 33 percent coinsurance for specialty drugs. Compared to 2009, this share is down modestly for PDPs but up substantially for MA-PD plans. In contrast, only 4 of the 35 national or near-national PDPs charged a 33 percent coinsurance rate for specialty tier drugs in 2006.
Jack Hoadley, PhD, a health policy analyst and political scientist at Georgetown University’s Health Policy Institute and co-author of the report, says, “There’s been an attempt to have a greater cost spread between the generics and branded drugs. That’s what we’re going to see happen in 2012.”
“On the generic side,” he says, “we’re going to see a split from one generic price to two tiers for generic drugs. Medicare is going to do its best to persuade its enrollees to choose generic drugs by adjusting copayments.”
Source: Georgetown/NORC analysis of data from CMS for MedPAC and the Kaiser Family Foundation; data for employer plans from Kaiser/HRET Employer Health Benefits Survey, 2010.