Study: 2015 Medicare Drug Plans Cover Fewer Drugs & Have More Restrictions

SUNNYVALE, Calif., Oct. 13, 2014 /PRNewswire-USNewswire/ -- HealthPocket analyzed government data on 2015 Medicare drug plans and found that the average number of covered drugs has decreased as compared to 2014 and the incidence of restrictions placed on covered drugs has increased. At an average of 1,485 drugs, Medicare Advantage plans in 2015 covered 5% more drugs than the average for 2015 Medicare Part D plans.

Given the number of covered drugs, the percentage of drugs with restrictions represents hundreds of on-formulary medications for the average Medicare drug plan. An average of 34% of covered drugs in Medicare Advantage plans have restrictions placed on the coverage. For Medicare Part D plans, the level of drug restrictions is even higher at 37%. For both Medicare Advantage and Medicare Part D plans, the most common drug restriction is prior authorization. Prior authorization requires a healthcare provider to contact the enrollee's insurance plan and obtain pre-approval for prescribing a particular medication before that medication may be obtained by the enrollee. Approval of the request is not guaranteed though the government does have an appeal process that can be pursued in the event of a denial.

Drug restrictions may be employed by an insurer for numerous reasons ranging from patient safety to cost containment. Since drug restrictions can affect access to medications as well as convenience, Medicare enrollees should investigate if any of the drugs they take have restrictions prior to enrollment within a Medicare drug plan and decide whether the restrictions are acceptable for their personal circumstances. If the restriction is not acceptable, other Medicare drug plans can be explored since drug restrictions are not uniform across Medicare drug plans.

"Both drug coverage and drug restrictions can change year to year even within the same Medicare insurance plan," said Kev Coleman, Head of Research & Data at HealthPocket, "so it's important for seniors to investigate all their options during this year's annual enrollment period."

The full results of the study can be reviewed at 2015 Medicare Drug Plan Medicare Coverage and Restrictions. 2015 Medicare drug plan cost and availability can be reviewed at HealthPocket.com.

HealthPocket.com is a free website that compares and ranks all health insurance plans available to an individual, family, or small business to allow consumers to make their best health plan decision and reduce their out of pocket costs. HealthPocket uses only objective data from government, non-profit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource. Learn more at www.HealthPocket.com.   

For more information, please contact Ryan Hughes, Shirley & Banister Public Affairs at [email protected] or 703-739-5920/800-536-5920.

SOURCE HealthPocket