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Trends that Matter for Medicare Coverage

Posted by Matt Breese on May 4, 2016

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The following infographics highlight how Medicare health plans cover treatments in trending therapeutic areas. Typically, Medicare Part D formularies implement more restrictive reimbursement controls, as compared to commercial formularies.

Immunology: This category includes treatments indicated for rheumatoid arthritis, Crohn's, psoriatic arthritis and psoriasis. For Medicare Part D formularies, these treatments are not covered for 52% of payer-controlled lives, with another 42% restricted by PA or step therapy policies. Click on the image to view more.


Cystic Fibrosis: An analysis of payer pharmacy benefit coverage for Medicare Part D plan sponsors shows that formularies do not cover CF treatments for around one-quarter of lives, with an additional one-half of lives restricted by a PA or step therapy. Click on the image to view more.



Multiple Sclerosis: A review of payer-controlled pharmacy benefit coverage for MS treatments shows that over 9 in 10 lives are either restricted by utilization management policies or not covered entirely. Click on the image to view more.


Narcotic Pain: For narcotic pain treatments, 9% of payer-controlled Medicare Part D lives are restricted by PA or step therapies and around 80% of these formularies do not cover the average branded narcotic pain treatment. Click on the image to view more.


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Topics: Specialty, Industry Trends, Payer