| 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 |
|
