BY GREGORY A.
FREEMAN | JUNE 25, 2018
Expensive drugs often are not covered by even the plans offering
the best benefits in return for higher premiums.
The highest monthly premiums in Medicare Part D and Medicare
Advantage plans do not always guarantee better coverage for specialty drugs,
according to recent research.
The study from HealthPocket, a website that compares and ranks all health
insurance plans, looked at the challenges facing beneficiaries in 2018 Medicare
Part D and Medicare Advantage plans when trying to find the most extensive
specialty drug coverage.
Coverage for specialty drugs is particularly important for some
consumers because the medications can cost thousands of dollars per month if
obtained out-of-pocket. Medicare drug plans can reduce those costs if the
specialty drug is on formulary and but they often are not.
Medicare beneficiaries in this situation can petition a plan for a
formulary exception, but the request can be denied. If they want to find a new
health plan that covers the specialty drug, they usually must wait for the next
enrollment period.
These are other findings from the research:
·
The average Medicare Advantage plan had more specialty drugs (635)
listed on its formulary than the average Part D plan (531).
·
However, the insurance plan with the largest coverage of specialty
drugs in 2018 was a Medicare Part D plan, Educators Rx Advantage (PDP) offered
in Utah and Idaho, with 952 specialty medications covered.
·
The plans with the fewest specialty drugs listed in their
formularies (301) came from the Medicare Advantage category.
·
Paying the highest monthly premium did not obtain the broadest
specialty drug coverage. (Health plans do not claim that it does.)
·
Blue Cross MedicareRx Plus (PDP)
offered in Texas had the highest monthly Part D premium of $197.10 but only
covered 642 specialty drugs as compared to the 952 specialty drugs in the plan
with the broadest coverage.
·
Among traditional Medicare Advantage plans, Medicare Plus Blue PPO Assure (PPO)
from Blue Cross Blue Shield of Michigan had the highest monthly premium at
$312.50 and covered 609 specialty drugs.
·
A "Cost Plan" version of Medicare Advantage,HealthPartners Freedom Ultimate with Enhanced Rx
(Cost), in Minnesota had an even higher monthly premium at
$375.90 and listed 680 covered specialty drugs.
·
The average 5-star Part D plan covered 495 specialty drugs, which
is fewer than the 531 average for Part D plans as a whole. 5-star Medicare
Advantage plans fared better than 5-star Part D plans.
·
On average, 5-star Medicare Advantage plans covered 606 specialty
drugs, fewer than Medicare Advantage plans as a whole (635) but more than the
average for 5-star Part D plans (495).
HealthPocket recommends that Medicare insurance comparison
websites present the number of covered drugs and the number of covered
specialty drugs for each Medicare drug plan.
Gregory
A. Freeman is a contributing writer for HealthLeaders.
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