Medicare Part D : spending, beneficiary cost sharing, and cost-containment efforts for high-cost drugs eligible for a specialty tier : report to the Chairman, Subcommittee on Health, Committee on Ways and Means, House of Representatives.

Format:

Book

Government document

Author/Creator:

United States. Government Accountability Office

Contributor:

United States. Congress. House. Committee on Ways and Means. Subcommittee on Health

Language:

English

Subjects (All):

Centers for Medicare & Medicaid Services (U.S.).

Medicare--Economic aspects--United States.

Medicare.

Pharmaceutical services insurance--Economic aspects--United States.

Pharmaceutical services insurance.

Medicare Part D--economics.

Insurance, Pharmaceutical Services--economics.

Cost Control--economics.

United States.

Medicare--Economic aspects.

Medical Subjects:

Medicare Part D--economics.

Insurance, Pharmaceutical Services--economics.

Cost Control--economics.

United States.

Physical Description:

1 online resource (ii, 38 pages) : illustrations

Other Title:

Spending, beneficiary cost sharing, and cost-containment efforts for high-cost drugs eligible for a specialty tier

Medicare Part D specialty tier-eligible drugs

Place of Publication:

[Washington, D.C.] : U.S. Govt. Accountability Office, [2010]

Summary:

The Centers for Medicare & Medicaid Services (CMS) allows Part D plans to utilize different tiers with different levels of cost sharing as a way of managing drug utilization and spending. One such tier, the specialty tier, is designed for high-cost drugs whose prices exceed a certain threshold set by CMS. Beneficiaries who use these drugs typically face higher out-of-pocket costs than beneficiaries who use only lower-cost drugs. GAO was asked to provide information about high-cost drugs eligible for a specialty tier. This report provides information on these drugs including spending under Medicare Part D in 2007, the most recent year for which claims data were available; how different cost-sharing structures could be expected to affect beneficiary out-of-pocket costs; how negotiated drug prices could be expected to affect beneficiary out-of-pocket costs; and information Part D plan sponsors reported on their ability to negotiate price concessions and to manage utilization. GAO examined CMS data, including 2007 claims data, negotiated price and out-of-pocket cost data for selected drugs--including the 10 highest-utilization specialty tier-eligible drugs in 2007--and plans from 2006 through 2009, and formulary information provided to CMS by plan sponsors. GAO interviewed officials from CMS and 8 of the 11 largest plan sponsors, based on enrollment in 2008. Seven of the 11 plan sponsors provided data including price concessions for selected drugs for 2006 through 2008.

Notes:

Title from title caption (GAO, viewed Apr. 19, 2010).

"January 2010."

Includes bibliographical references.

"GAO-10-242."

OCLC:

607933580