Formulary Analysis of Coverage for Critical Medications
Access to prescription drugs through Medicare Part-D is determined by
coverage and cost decisions made by insurers and by the ability of
consumers to understand their options and select a plan that bests fits
their health needs and economic circumstances.
This study of drug plan coverage is for a single class of innovative, high use, and costly medications—atypical antipsychotic drugs (i.e., Abilify, Clozapine, Risperidal, Geodon, Seroquel, and Zyprexa). Because mental illness is now the most common basis of SSDI eligibility, this class of medications is particularly relevant.
Plan information on coverage and cost will be collected annually for all Medicare prescription drug plans (PDPs) and Medicare Advantage plans (MAPs) in Washington State. Along with changes in the number and type of plans, the study will track changes in plan deductibles, coverage restrictions, and out of pocket costs. The impact of patent protections on out of pocket costs will also be examined, as some atypical antipsychotics will be losing patent protection and additional atypical antipsychotics are released.