Abstract
ObjectivesBiologic disease modifying anti-rheumatic drugs (DMARDs) are effective for the treatment of rheumatoid arthritis but also expensive. Medicare covers an important part of the cost of biologic DMARDs in the United States; however, studies examining the coverage and cost sharing in Medicare Part D are scarce. The purpose of this study was to examine the formulary coverage and cost sharing of biologic DMARDs in Medicare Part D in the period 2006 to 2015.
MethodsData for coverage and cost sharing of biologic DMARDs in Medicare Part D were gathered from the Centers for Medicare and Medicaid Services (CMS) Medicare Prescription Drug Plan Formulary and Pharmacy Network Files data for the months of December of the years 2006 to 2015. Descriptive statistics were performed.
Key findingsThe mean percentage of Medicare Part D formularies covering all biologic DMARDs in 2006 was 74.5%; the coverage reached its highest level (85.9%) in 2007 and declined to 73.8% in 2015. The percentage of formularies requiring prior authorization across biologic DMARDs ranged from 68.4% in 2006 to 93.1% in 2014. Placement in tiers 2-4 decreased during the study period. Coinsurance was the most commonly use type of cost sharing and was required by 62.3% of the formularies in 2006 and 68.4% in 2015.
ConclusionsAll Medicare Part D formularies covered at least one biologic DMARD. The majority of formularies placed restrictions on the utilization of biologic DMARDs. Additionally, biologic DMARDs were increasingly placed in higher specialty tiers that required high cost-sharing payments.