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Corporate Author United States. Government Accountability Office.

Title Medicare Part D [electronic resource] : 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.

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

Copies

Location Call No. OPAC Message Status
 Axe Federal Documents Online  GA 1.13:GAO-10-242    ---  Available
Description 1 online resource (ii, 38 p.) : ill.
Note Title from title caption (GAO, viewed Apr. 19, 2010).
"January 2010."
File Type Text in PDF format.
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.
Bibliography Includes bibliographical references.
Note "GAO-10-242."
Subject Centers for Medicare & Medicaid Services (U.S.)
Medicare -- Economic aspects -- United States.
Pharmaceutical services insurance -- Economic aspects -- United States.
Medicare Part D -- economics.
Insurance, Pharmaceutical Services -- economics -- United States.
Cost Control -- economics -- United States.
Added Author United States. Congress. House. Committee on Ways and Means. Subcommittee on Health.
Added Title Medicare Part D : spending, beneficiary cost sharing, and cost containment efforts for high cost drugs eligible for a specialty tier
Spending, beneficiary cost sharing, and cost-containment efforts for high-cost drugs eligible for a specialty tier
Running Title Medicare Part D specialty tier-eligible drugs
Gpo Item No. 0546-D (online)
Sudoc No. GA 1.13:GAO-10-242

 
    
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