Thesis
Comparison of Washington state 2010 Medicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence
Washington State University
Master of Health Policy and Administration (MHPA), Washington State University
2010
Handle:
https://hdl.handle.net/2376/100715
Abstract
Study Objectives The objective of this study is to assess the current cost and availability of antiaddiction medications in Medicare drug plans in Washington State. Specific Aims The specific aims of the study are: 1) to determine the proportion of Medicare drug plans that cover opioid and alcohol dependence medications; 2) to compare coverage rates and formulary restrictions placed on older generic medications and newer patent protected medications; 3) to contrast coverage of antiaddiction medications in Medicare Advantage Plans (MAPs) and in Medicare Prescription Drug Plans (PDPs); and 4) to assess variation in MAPs coverage of antiaddiction medications in rural and urban communities. Method: This study examines MAPs and PDPs coverage of seven different opioid and alcohol dependence medications; Buprenorphine (Suboxone®), Methadone (Methadose®), Naltrexone (ReVia®, Vivitrol®, and the generic formulation) Disulfiram (Antabuse®), and Acamprosate (Campral®). The data for this study was obtained for the Center of Medicare and Medicaid Services (CMS) website (www.medicare.gov) via the Medicare Prescription Drug Plan Finder section. This data was gathered in February, 2010. Results: The results indicate that both PDP and MAP coverage of substance dependence medications varies by patent protection status. Two thirds of PDPs and almost half of MAPs exclude Vivitrol. ReVia faces formulary exclusion from 80% of PDPs and almost 50% of MAPs. Suboxone is placed in the most expensive cost-sharing tiers in 60% of Medicare plans. Campral is also generally placed in tiers 3 or 4; while ReVia and Vivitrol (with the exception of three MAPs) are exclusively placed in the highest cost-sharing tiers. Coverage and cost structure of dependence medications did not significantly differ between MAPs and PDPs. No significant difference exists between MAPs coverage of dependence medication for beneficiaries living in rural as compared to urban localities. Conclusion: Antiaddiction medications are usually covered, but the out-of-pocket costs may restrict access for some enrollees. Both MAPs and PDPs place patent protected medications on higher cost-sharing tiers which discourages beneficiaries' utilization of these medications. This is of particular importance for Suboxone, Campral, and Vivitrol as generic substitutes for these medications are not currently available.
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Details
- Title
- Comparison of Washington state 2010 Medicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence
- Creators
- Aaron Dipzinski
- Contributors
- Jae Kennedy (Degree Supervisor)
- Awarding Institution
- Washington State University
- Academic Unit
- Health Policy and Administration, Department of
- Theses and Dissertations
- Master of Health Policy and Administration (MHPA), Washington State University
- Publisher
- Washington State University; Pullman, Wash. :
- Identifiers
- 99900525087201842
- Language
- English
- Resource Type
- Thesis