Juliette Cubanski Follow @jcubanski on
Twitter, Karyn Schwartz, and Anthony Damico Published: Mar 20, 2020
In response to the ongoing coronavirus
pandemic, current recommendations are for older adults to stay home
and away from others. To prepare for extended stays at home, the Centers for
Disease Control and Prevention (CDC) recommends gathering extra supplies, including prescription medicines.
Some patients may encounter difficulty in doing so, however, as a result of
their health plan’s ‘refill too soon’ restrictions, which block coverage for a
prescription that is being refilled early. For example, a plan may have a
policy of not allowing refills of 30-day prescriptions until at least three weeks
after the prescription was last filled.
In a recent memo, the Centers for Medicare & Medicaid
Services (CMS) reminded Medicare Part D plan sponsors, which provide drug
coverage to 45 million older adults and people
with disabilities, that they have the option to relax their ‘refill too
soon’ restrictions in response to the COVID-19 pandemic, as part of efforts to
ensure adequate access to medications in disasters or emergencies. These
restrictions could prevent Part D enrollees from obtaining a sufficient
extended supply to meet their needs if they adhere to current recommendations to avoid public spaces or if they
are quarantined, requiring them to act contrary to these recommendations if
they should need to visit a pharmacy to refill their prescriptions. This
analysis examines the share of Part D enrollees who currently have access to
extended supplies of generic, brand-name, and specialty-tier drugs covered by
their plan in 2020, prior to relaxation of any early-fill restrictions in
response to the COVID-19 outbreak.
Findings
·
In 2020,
three-quarters of Medicare Part D enrollees (27.5 million enrollees) are in a
plan that covers extended supplies of all drugs on at least one of the plan’s
two tiers for generic drugs (Figure 1).
·
Nearly half of all
Part D enrollees (47%, or 17.5 million enrollees) are in a plan that covers
extended supplies of all drugs on at least one of the plan’s two tiers for
brand-name drugs.
·
Only 4 percent of Part
D enrollees (1.5 million) are in a plan that covers extended supplies of all
specialty tier medicines. Specialty tier medicines are defined by Medicare as
medicines that cost more than $670 per month and include drugs to manage
conditions such as cancer, hepatitis C, multiple
sclerosis, and rheumatoid arthritis.
·
A larger share of
stand-alone drug plan enrollees than Medicare Advantage drug plan enrollees are
in plans covering extended supplies of generic drugs (80% vs. 67%,
respectively) and brand drugs in 2020 (56% vs. 37%, respectively), but the
opposite is true for specialty tier drugs (2% vs. 6%, respectively) (Figure 2).
Figure 1: Most
Medicare Part D Enrollees Are in Plans Covering Extended Supplies of Generic
Drugs, But Only 4% Are in Plans Covering Extended Supplies of Specialty Tier
Drugs
Figure 2: A Larger Share of Stand-Alone Drug Plan Enrollees Than
Medicare Advantage Drug Plan Enrollees Are in Plans Covering Extended Supplies
of Generic and Brand Drugs, But the Opposite is True for Specialty Tier Drugs
Discussion
This analysis shows that most Medicare Part D
enrollees are in plans covering extended supplies of relatively low-cost
generic drugs in 2020, but just under half are in plans that cover extended
supplies of brands and only a small share of enrollees are in plans that cover
extended supplies of more expensive specialty-tier medications. In response to
the coronavirus pandemic, some Part D plans are temporarily lifting restrictions on
their “refill too soon” policies, while others may be making exceptions on a case-by-case basis,
in order to provide their enrollees with access to extended supplies of
essential medications. Pharmacists may be able to help Part D enrollees obtain
coverage for extended day supplies, but having different health plans with
different policies may increase the amount of time and effort required to
determine whether their patients will be able to get extended supplies as needed.
It is unknown how many Medicare Part D enrollees are aware of this potential
flexibility or how many will attempt to take advantage of it in response to the
coronavirus pandemic. Beneficiaries who previously might have had trouble
obtaining an extended supply of their medication may assume that they would
encounter similar difficulty now and not request this option.
In light of the CDC recommendations for older adults and people with
serious chronic medical conditions to take actions to reduce the risk of
becoming infected with the new coronavirus, including staying home and having extra supplies of necessary
medications, efforts to create a more uniform set of policies governing early
refills and extended day supplies, consistent with CDC recommendations during
the national emergency, could help Medicare beneficiaries avoid trips to the
pharmacy when there is increased risk of spread of coronavirus in their
communities.
Juliette Cubanski and
Karyn Schwartz are with KFF. Anthony Damico is an independent consultant.
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Data and Methods
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This analysis is
based on 2020 Medicare Part D plan enrollment and benefit data. The analysis
focuses on 36.9 million Part D enrollees who are in a non-employer Part D
plan (including both stand-alone prescription drug plans and Medicare
Advantage drug plans) with five or six formulary tiers in 2020 (93% of all
non-employer Part D enrollees). The analysis excludes 7.0 million enrollees
in employer group health insurance plans that offer Part D coverage because
details on their plan benefits are not available.
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