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Fingertip Formulary Insights™ is a series of ongoing reports that analyzes various important aspects of the managed care marketplace. As always, we welcome your feedback. We hope you find this report informative and we welcome your suggestions for future topics.
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Archives
December 2007: Lack of Impact from Two Key Generics in the Anti-depressant Formulary Market
October 2007: Formulary Position Differences between Commercial and Medicare Plans
September 2007: Impact of Patent Loss for Zocor on the Statin Marketplace
- Intro
- Formulary Access
- Trend Analysis
- Prior Authorization
- Quantity Limits
- Step Therapy
- Strategic Implications
Featured article: Formulary Position Differences between Commercial and Medicare Plans
Executive Summary
With the introduction of Medicare Part D two years ago, numerous health plan providers entered the Medicare market by establishing distinct formularies for their Medicare prescription plans. In this issue of Fingertip Formulary Insights™, we examine the differences in formulary status between commercial and Medicare plans. We set out to understand if there were significant differences in overall access, measured by tier status, as well as in managed care restrictions between commercial and Medicare plans.
Methods
We utilized the Fingertip Formulary Analytics® platform and analyzed the formulary status of key drugs in five therapeutic areas for commercial and Medicare plans. We selected top selling drug classes that we believe provide interesting case studies. For each drug class, we calculated the average formulary position (measured as a percentage of covered lives) of selected top selling drugs. Of note, we included the erectile dysfunction drug class although Medicare plans typically do not reimburse for these products. In addition, we evaluated tier status trends over time using the Fingertip Formulary Analytics Trend Report.
The following drug classes and drugs were included in this report:
| Drug Class Analyzed | Selected Drugs |
|---|---|
| Statins |
|
| Angiotensin Receptor Blockers (ARBs) |
|
| Proton Pump Inhibitors (PPIs) |
|
| Osteoporosis |
|
| Erectile Dysfunction (ED) |
|
Findings
There were no consistent trends, overall, across drug classes between commercial and Medicare plans when formulary position was compared. However, statins and PPIs had meaningful differences in formulary position between commercial and Medicare plans. Trend analysis demonstrated that these differences in formulary access were new over the past year.
Prior authorization restrictions were significantly more prevalent on commercial plans across most therapeutic areas.
In contrast to prior authorization, quantity limits were significantly more common in Medicare plans. This finding was present for all drug classes, except for erectile dysfunction, which is typically an excluded drug class for Medicare beneficiaries.
Step therapy restrictions were a mixed bag, with no consistent trend across therapeutic areas.