An Analysis of Exchange Plan Benefits for Certain Medicines

Transcription

1 An Analysis of Exchange Plan Benefits for Certain Medicines June 2014

2 In Seven of the Selected Classes, Over One-Fifth of Silver Plans Require Coinsurance of 40 Percent or More for All Drugs in Class 60% 50% PERCENTAGE OF SILVER PLANS REQUIRING COINSURANCE OF 40% OR HIGHER FOR ALL DRUGS IN THE CLASS Percent of Plans 40% 30% 20% 10% 0% HIV/AIDS Mental Health Oncology Diabetes MS Asthma RA 39% of plans require coinsurance of 40% or higher for ALL covered drugs in at least one class * = no generics in the class 2

3 In Ten Classes, Over One-Fifth of Silver Plans Require Coinsurance of 30 Percent or Greater for All Drugs in the Class 60% 50% PERCENTAGE OF SILVER PLANS REQUIRING COINSURANCE OF 30% OR HIGHER FOR ALL DRUGS IN THE CLASS Percent of Plans 40% 30% 20% 10% 0% HIV/AIDS Mental Health Oncology Diabetes MS Asthma RA 52% of plans require coinsurance of 30% or higher for ALL covered drugs in at least one class * = no generics in the class 3

4 Over 60 Percent of Silver Plans Place All Covered Drugs in MTI, Antiangiogenic, and MS Agent Classes on Highest Tier Percent of Plans 80% 70% 60% 50% 40% 30% 20% 10% 0% PERCENTAGE OF SILVER PLANS PLACING ALL COVERED DRUGS IN THE CLASS ON THE PLAN S HIGHEST FORMULARY TIER HIV/AIDS Mental Health Oncology Diabetes MS Asthma RA 86% of plans place ALL covered drugs in at least one class on the highest formulary tier * = no generics in the class 4

5 Methodology: Analysis Focuses on 123 Formularies from Plans Expected to Capture Significant Exchange Enrollment 123 FORMULARIES FROM PLANS REPRESENTING MOST MAJOR ISSUERS The analysis includes formularies from plans offered in a zip code in the largest city(s) in each state Formularies include: Low-cost silver and bronze plan options Low-cost strategic players (e.g., Blues, Medicaid managed care plans) Additional formularies in states with a high number of silver plan options and very high enrollment Silver plan variations available to consumers with income between 100% and 250% of the Federal Poverty Level are not included in this analysis Most carriers use similar formularies across metal tiers and network type within a given state 5

6 Methodology: Detailed List of Classes Selected DISEASE STATE USP CATEGORY USP CLASS ABBREVIATION HIV/AIDS Antivirals Anti-HIV agents, non-nucleoside reverse transcriptase inhibitors NNRTIs Anti-HIV agents, nucleoside and nucleotide reverse transcriptase inhibitors Anti-HIV agents, protease inhibitors NRTIs Pis Anti-HIV agents, other HIV-Other 1 Mental Health Antidepressants Serotonin/ Norepinephrine reuptake inhibitors SSRIs/SNRIs Antidepressants, other AD-Other Antipsychotics 2 nd generation/ atypical Atypicals Bipolar Agents Bipolar Agents-Other Bipolar-Other Oncology Metabolic Bone Disease Agents No class Bone Disease Antineoplastics Alkylating agents Alkylating Molecular target inhibitors Antiangiogenic agents MTIs Antiangiogenics Antiemetics Emetogenic Therapy Adjuncts Emetogenics Diabetes Blood Glucose Regulators Antidiabetic agents Antidiabetics Insulins Insulins Rheumatoid Arthritis Immunological Agents Immune suppressants Immunosup Multiple Sclerosis Central Nervous System Agents Multiple Sclerosis Agents MS Asthma Respiratory Tract Agents Bronchodilators, Sympathomimetic B 2 agonists Anti-inflammatories, Inhaled Corticosteroids ICS 6