Medicare Drug Benefit
The Medicare drug benefit could expand beneficiaries' access to cancer treatments because of the typically low copayments for the drugs and the range of brand-name and generic drugs covered, a study published in Health Affairs found.
For the study, researchers used a drug compendium to compile a list of cancer drugs that were not covered under Medicare Part B -- which pays for outpatient, physician and some other medical services. The study authors then used the Feb. 1 extract of the CMS Prescription Drug Plan Formulary and Pharmacy Network Files to determine coverage and copay or coinsurance rates of the drugs.
The researchers found that Medicare prescription drug plans covered 75% of cancer drugs evaluated and noted that such plans cover generic drugs more often than brand-name drugs. According to the study, prescription drug plans in most cases covered the generic equivalent of a brand-name treatment if the plan did not cover the actual brand-name drug.
The authors recognized that prescription drug plans often require prior authorization for brand-name medications and that the practice can control costs, but they found that prior authorization also might limit access to important cancer medications (Bowman et al., Health Affairs, September/October 2006).