Coverage of New Drugs in Medicare Part D.

ABSTRACT: Policy Points Only a small minority of new drugs in "nonprotected" classes are widely covered by Part D plans nationwide in the year after US Food and Drug Administration (FDA) approval. Part D plans frequently apply utilization management restrictions such as prior authorizations to newly approved drugs in both protected and nonprotected classes. Drug price influences both formulary inclusion (in nonprotected classes) and coverage restrictions (in both protected and nonprotected classes), while other drug characteristics such as therapeutic benefits are not consistently associated with formulary design. Plans do not seem to favor the minority of drugs that are determined to offer added therapeutic benefit over existing alternatives.

Context

Medicare Part D is an outpatient prescrip

SUBMITTER: Naci H 

PROVIDER: S-EPMC9205672 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature