58% of Part D Covered Drugs Subject to Coinsurance

Avalere recently conducted an analysis on prescription drug coverage for Medicare Part D (PDPs) and Medicare Advantage (MA-PDs) plans. Here are some key findings from the report:

·         The percentage of covered drugs facing coinsurance rose from 35% in 2014 to 58% today among PDPs.

·         24.6 million Medicare beneficiaries are currently enrolled in PDPs.

·         96% of PDP members are enrolled in plans with more than 1 tier requiring coinsurance, vs. 39% in 2014.

·         Medicare rules cap the amount of coinsurance for specialty tiers at 33% of the cost of the product.

·         The maximum cap on non-preferred brand tiers is 50%, while preferred brand tiers are capped at 25%.

·         Medicare Advantage plans currently charge coinsurance for 26% of covered drugs.

Source: Avalere, March 10, 2016