by Leslie Small
A recently published
study in Health Affairs shines a light on a peculiar quirk of the Medicare Part
D benefit structure: For some high-priced specialty medications, seniors might
pay less out-of-pocket for brand-name drugs than their generic counterparts.
The study found that,
assuming a 61% discount between brand-name and generic drugs, Part D
beneficiaries with prescriptions costing between $22,000 and $80,000 per year
would have lower out-of-pocket spending if they use brand-name drugs over a
generic.
"That's really
frustrating for consumers because you may actually not be in a plan that allows
you to switch to a branded drug" if it's cheaper than the generic, says
Stacie Dusetzina, one of the study authors and an associate professor at
Vanderbilt University.
"The other practical
thing is, that would a terrible thing for us to be trying to get people to do
because generally we want to encourage people to use generic drugs because
they’re the best deal for us as a society," she says.
Sharon Jhawar, chief pharmacy
officer at California-based SCAN Health Plan, points out that because most
generic prescriptions filled by seniors are not pricey specialty ones,
"this kind of nuance that's happening [with the Part D benefit] is kind of
narrow and limited in scope."
"But we know that
the specialty pipeline is robust," and so taking a look at the problem and
figuring out solutions "does make sense," she says.
However, well-intentioned
policy changes don't always turn out as planned, notes Kelly Brantley, a
managing director at Avalere.
"Part D is so
complicated, it’s hard to know what sort of fixes drive other quote-unquote
problems," she says.
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