Avalere released a study analyzing consumer access to anticonvulsants by each drug’s presence on the formulary, level of cost-sharing, and utilization management techniques. Overall, the study concluded that:
- Commercial plans had higher levels of coverage of anticonvulsants on formularies than Part D PDPs, including more coverage of brand-name and extended release products.
- Commercial plans placed more covered anticonvulsants on lower tiers than Part D PDPs.
- Cost-sharing on tiers one and two were higher for commercial plans than Part D PDPs. For tiers three and four, cost-sharing was nearly level among both sets.
- For a medicine placed on a specialty tier, the difference in cost-sharing between coinsurance and a fixed copayment could be substantial. According to a recent report by the Government Accountability Office, the median negotiated price of all specialty tier-eligible drugs in 2007 was $1,100. Under a commercial plan with a $1,100 specialty drug on the highest tier, a patient would pay $79 a month on average. In contrast, a Medicare beneficiary enrolled in a Part D PDP would pay 30 percent, or $330 a month, on average for the same medicine.
- Usage of utilization management techniques was fairly similar among Part D PDPs and commercial plans.