The Government Accountability Office (GAO) recently released a report on Medicare Part D which found that nearly 90 percent of mid-year changes to the plan were formulary enhancements.
Formulary enhancements can add a drug to the formulary or remove or loosen restrictions on a drug. Such enhacements accounted for 87.4 percent of formulary changes in 2008 and 88.6 percent in 2009. Negative changes, such as removing a drug from a formulary, accounted for 12.6 percent of changes in 2008 and 11.4 percent in 2009. Additionally, in 2008 about 5 percent of beneficiaries (over 1.1 million beneficiaries) filled a prescription for a drug that was later affected by a negative mid-year change.
Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt said of the GAO report, "While experts agree that pharmacy benefit managers (PBMs) help Part D come in under budget each year, GAO's new report provides fresh evidence that the Medicare drug benefit also expands access to new medications."
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According to Merritt, in the few cases when a drug is no longer covered under Part D, it's usually because a generic version of that drug has become available.
"This is in stark contrast to Medicaid's expensive, fee-for-service approach to pharmacy, which contributes to spiraling deficits in states all across America," Merritt said.
According to a recent report by the Lewin Group, states and the federal government could save $33 billion – without cutting benefits for patients or payments to doctors and hospitals – by updating Medicaid pharmacy benefits.
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