Medicare Rx Plans To Cover Fewer Medications

Armen Hareyan's picture

Medicare Rx Plans

The number of medications covered under Medicare prescription drugplans offered by the 10 health insurers with the largest enrollmentwill decrease next year by 26%, according to a recent analysis by Avalere Health, USA Today reports. According to the analysis, the number of medications covered under Medicare prescription drug plans offered by UnitedHealth and Humananext year will decrease by 30%, from more than 3,750 treatments to morethan 2,620, although the plans will continue to have some of thelargest formularies available.


The decrease in the number ofmedications covered under Medicare prescription drug plans will occur"mainly because of changes made by Medicare," which no longer willreimburse plans for treatments that FDA has removed from the market, are considered less than effective, have duplicative billing codes or are no longer manufactured, USA Today reports.

CMSofficials and health insurers maintain that the decrease likely willnot affect Medicare beneficiaries who take medications no longercovered by prescription drug plans because they will have access toalternative treatments and can use an appeals process to seek continuedcoverage of their current treatments. Humana spokesperson Tom Nolandsaid, "As the Part D program develops, the size of the formulary isbecoming more aligned with utilization patterns, consumer preferences,health outcomes and value for consumers" (Appleby, USA Today, 12/4).

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