Coverage for hepatitis C drugs in Medicare Part D

Area of Science:

• Hepatology
• Health Economics
• Pharmaceutical Policy

Background:

• New hepatitis C virus (HCV) drugs have significantly increased Medicare Part D spending.
• HCV drug costs rose from $283 million in 2013 to $4.5 billion in 2014.

Purpose of the Study:

• Examine Medicare Part D benefit designs for HCV drugs.
• Analyze the financial burden on patients for HCV medications.

Main Methods:

• Cross-sectional analysis of July 2015 Medicare Part D Plan Formulary File.
• Utilized Medi-Span Electronic Drug File v.2 for drug cost data.
• Assessed cost-sharing, utilization management, and estimated patient out-of-pocket spending.

Main Results:

• All Part D plans covered at least one new HCV drug by July 2015.
• Most plans featured high coinsurance and prior authorization requirements for HCV drugs.
• Non-subsidized enrollees faced mean out-of-pocket costs from $6297 to $10,889 for a full treatment course.

Conclusions:

• Patients with HCV and no Medicare Part D subsidy face substantial financial burdens for treatment.
• Current benefit designs may hinder access to critical HCV medications, especially for the aging population.
• Policy efforts are needed to ensure patient access to necessary HCV therapies.