Huiwen Deng, Sarah Lothspeich, Darin Meinen, Abigail ... · Huiwen Deng, Sarah Lothspeich, Darin...
Transcript of Huiwen Deng, Sarah Lothspeich, Darin Meinen, Abigail ... · Huiwen Deng, Sarah Lothspeich, Darin...
Huiwen Deng, Sarah Lothspeich, Darin Meinen, Abigail SakellarisMentored by Dr. Urmie
Formularies are important for patient access
Cost affects adherence
Formularies differ between plans
Especially regarding specialty medications
ACA Pre-Existing Conditions Mandate
Formularies can be a way around this
Pharmacists as a patient advocate
To evaluate different formularies in both PartD and ACA Exchange plans that are available in Wisconsin, Texas, Pennsylvania and Oregon to compare the coverage of specialty drugs required for Cystic Fibrosis and Dementia.
Examined disease states requiring specialty drugs Made a comprehensive list of drugs used for 4 specialty
disease states looking at 2-3 different plan formularies Looked at variation in formulary coverage and selected
Cystic Fibrosis and Dementia due to higher variation Surveyed states existing PartD and ACA Exchange
Plans Looked at number of insurance companies/plans offered
Locations selected Wisconsin (53719) Texas (75201) Pennsylvania (15214) Oregon (97205)
Chose ACA Exchange plans and PartD plans offered using the previous zip codes
Exchange Plans (through healthcare.gov)
Used silver plans if 4 different companies
If there were less than 4 companies used 1 silver plan from each company plus a bronze or gold to get to 4 total plans
Enrollment Nov. 1st
through January 31st
PartD Plans (through Medicare.gov) Typed in a common set of drugs (including at least
2 from each drug class) and chose a pharmacy
Careful to choose plans not requiring preferred pharmacies
1 plan was chosen from each of the four quartiles (e.g. 1 plan will be from the top 25% of plans by cost)
Enrollment Oct. 15th
through Dec. 7th
Data collected
Both disease states used the same ACA Exchange and PartD plans (same formularies)
Examined cost sharing (premium costs, out-of-pocket costs, deductible amounts)
Examined formulary/non-formulary, PA requirement, step therapy requirement, supply limit and specific tier
0% 20% 40% 60% 80% 100% 120%
Cayston
Orkambi
Kalydeco
Pulmozyme
Tobi
Tobramycin
Percent of Cystic Fibrosis Drugs on Formulary
Part D Plan Exchange Plans
Exchange Plans Part D Plan
Cayston 100% 94%
Orkambi 77% 100%
Kalydeco 92% 100%
Pulmozyme 100% 100%
Tobi 62% 56%
Tobramycin 85% 81%
0% 20% 40% 60% 80% 100% 120%
Cayston
Orkambi
Kalydeco
Pulmozyme
Tobi
Tobramycin
Percent of Plans Requiring a PA for Cystic Fibrosis Dugs
Part D Plan Exchange Plans
Exchange Plans Part D Plan
Cayston 69% 73%
Orkambi 100% 100%
Kalydeco 92% 94%
Pulmozyme 62% 63%
Tobi 67% 67%
Tobramycin 64% 69%
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
Cayston Orkambi Kalydeco Pulmozyme Tobi Tobramycin
Average Cystic Fibrosis Drug Cost in Exchange Plans by State
Wisconsin Texas Pennsylvania Oregon
0
5000
10000
15000
20000
25000
30000
Cayson Orkambi Kalydeco Pulmozyme Tobi Tobramycin
Average Cystic Fibrosis Drug Cost in PartD Plans by State
Wisconsin Texas Pennsylvania Oregon
0% 20% 40% 60% 80% 100% 120%
Namzaric
Namenda
Memantine HCl
Razadyne
Galantamine Hydrobromide
Ergoloid Mesylate
Rivastigmine
Exelon
Donepezil
Percentage of Dementia Drugs on Formulary
Part D plans Exchange plans
Exchange plans Part D plans
Namzaric 31% 81%
Namenda 69% 81%
Memantine HCl 100% 100%
Razadyne 23% 6%
Galantamine Hydrobromide 100% 94%
Ergoloid Mesylate 92% 44%
Rivastigmine 100% 100%
Exelon 38% 19%
Donepezil 100% 100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Namzaric
Namenda
Memantine HCl
Razadyne
Galantamine Hydrobromide
Ergoloid Mesylate
Rivastigmine
Exelon
Donepezil
Percentage of Plans that Required PA for Dementia Drugs
Part D plans Exchange plans
Exchange plans Part D plans
Namzaric 25.0% 53.8%
Namenda 33.3% 92.3%
Memantine HCl 15.4% 81.3%
Razadyne 66.7% 0.0%
Galantamine Hydrobromide 7.7% 0.0%
Ergoloid Mesylate 8.3% 57.1%
Rivastigmine 15.4% 0.0%
Exelon 75.0% 0.0%
Donepezil 7.7% 0.0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Donepezil
Exelon
Rivastigmine
Ergoloid Mesylate
Galantamine Hydrobromide
Razadyne
Memantine HCl*
Namenda
Namzaric
Tier Ranges for Dementia Drugs in Exchange plans
Tier 4 Tier3 Tier2 Tier1
0% 10% 20% 30% 40% 50% 60% 70% 80%
Donepezil
Exelon
Rivastigmine
Ergoloid Mesylate
Galantamine Hydrbromide
Razadyne
Memantine HCl
Namenda
Namzaric
Tier Ranges for Dementia Drugs in Part D plans
Tier 4 Tier 3 Tier 2 Tier 1
Medicare Part D vs ACA Exchange Both Medicare Part D and ACA Exchange plans have
similar percentages of the dementia drug class on formulary
The Medicare Part D plans tend to have more restrictions for dementia drugs when compared to the exchange plans
Medicare Part D plans and Exchange plans for Cystic Fibrosis were similar in terms of formulary restrictions and PA requirements
Largest difference was cost variation between states for Exchange plans
Overall, patients should choose plans carefully to ensure the lowest out of pocket cost and best coverage
Huiwen Deng, Sarah Lothspeich, Darin Meinen, Abigail SakellarisMentored by Dr. Urmie
QUESTIONS?
http://bit.ly/DiscoveryUrmie