Coverage of Atypical Antipsychotics Among Medicare Drug Plans in the State of Washington for Fiscal Year 2007
Prim Care Companion J Clin Psychiatry 2008;10(4):313-317
© Copyright 2016 Physicians Postgraduate Press, Inc.
Objective: To examine drug coverage and
patient costs for 6 atypical antipsychotics
(olanzapine, quetiapine, ziprasidone, aripiprazole,
clozapine, and risperidone) in Medicare Part D formularies using health plan data from the
state of Washington.
Method: Fiscal year 2007 coverage and
cost-sharing characteristics for 57 prescription
drug plans (PDPs) and 43 Medicare advantage prescription drug plans (MAPDs) were
collected from the Centers for Medicare and Medicaid
Services. Plans were compared in terms of
formulary restrictions, out-of-pocket costs, and
premium charges. Medicare released plan information
for fiscal year 2007 in October 2006. Data were
collected for this study in February 2007.
Results: Almost all plans covered the 6
atypical antipsychotics. The PDPs were more likely
to restrict coverage than the MAPDs. Prior authorization requirements were enforced in 5% to
21% of plans, depending on plan type and
medication. Monthly drug plan premiums were higher
for PDPs than MAPDs, but the MAPDs had concurrent monthly health premiums. About 80%
of MAPDs and 60% of PDPs also had no annual deductible for medications. The patient
out-of-pocket cost for atypical antipsychotics varied
depending on the stage of coverage-median monthly drug costs ranged from $5 to $50 during the
initial period, but if costs exceeded the annual
cap, patients were responsible for the full cost of
the drug, which ranged from $292 to $665. Patients with low incomes and those who exceeded
the annual spending limit ($3850 in fiscal year
2007) had a median monthly cost of $17 to $33.
Conclusions: There is considerable
variation across health plans in terms of patients'
out-of-pocket drug costs. Given the significant
needs and vulnerabilities of Medicare beneficiaries
with mental illness, changes for atypical
antipsychotic coverage should be monitored carefully, and
the complexity of Medicare drug plans should be minimized.