Certain exchange benefit plans have recently begun to place all specialty medications for complex diseases on the highest drug formulary cost-sharing tier, according to an analysis from Avalere Health.
Certain exchange benefit plans have recently begun to place all specialty medications for complex diseases on the highest drug formulary cost-sharing tier, according to an analysis from Avalere Health.
The report found that plans placed 5 of the 20 drug classes studied on the specialty tier and of the multiple sclerosis agents alone, 50% of plans placed both the branded drugs and generic versions on the highest tier. Additionally, a subset of plans in 10 drug classes listed all single-source branded drugs in a class on the specialty tier and 8 of those drug classes that consisted of single-source branded drugs were more likely to be listed on the highest cost-sharing tier in 2015 than in 2014.
“Enrolling in a plan that places all medications for a particular disease on the specialty tier can mean significant out-of-pocket costs for consumers, particularly if they do not qualify for cost sharing reductions,” Caroline Pearson, vice president of Avalere, said in a statement. “Plans that place some drugs in a class on lower tiers may allow consumers to find lower cost alternatives.”
Taking into account individual based variables, such as subsidies, out-of-pocket-limits and overall plan benefit design, researchers at Avalere Health highlighted that 8 in 10 individuals received a premium tax credit by selecting an exchange plan in 2015, which lowered monthly premium costs by nearly 75%.
Lack of Mutations Associated With Favorable Prognosis in MPN-U
April 25th 2024While the Dynamic International Prognostic Scoring System and bone marrow blasts may predict overall survival, the lack of certain mutations is also associated with a better prognosis for myeloproliferative neoplasm, unclassifiable (MPN-U).
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
Dr Dalia Rotstein: Physicians Must Be Aware MS Affects People of All Backgrounds
April 24th 2024Dalia Rotstein, MD, MPH, emphazises the importance of awareness that multiple sclerosis (MS) impacts patients from various backgrounds as clinicians think through ways to improve access to care and research efforts in MS.
Read More
Data Back Neoadjuvant Combo vs Chemo Alone for Early-Stage NSCLC
April 24th 2024For patients with early-stage non–small cell lung cancer (NSCLC), combining neoadjuvant immune checkpoint inhibitors and platinum-based chemotherapy improves 2-year outcomes over chemotherapy alone, suggest findings of an extensive literature review and meta-analysis.
Read More