Prescription medications covered under Medicare's drug program vary widely but physicians should be able to find at least one option among the most popular classes of drugs, according to an analysis released Tuesday of California plans.
Overall, just 45 percent of drugs were widely covered among 72 plans in California, according to the analysis, and nearly all widely covered drugs — 94 percent — were generic, according to the study published in the Journal of the American Medical Association.
"The coverage of individual drugs varied extensively, indicating the potential difficulties that clinicians can face in knowing which drugs are covered or are more affordable," wrote study leader Dr. Chien-Wen Tseng of the John A. Burns School of Medicine at the University of Hawaii.
The Medicare drug benefit, called Part D, launched in January 2006 and was intended to provide relief from soaring drug costs to the nation's 44 million eligible Medicare beneficiaries, mostly over age 65.
Nearly 23 million people nationwide have signed up to participate in Part D, in which the federal government contracts with private insurers to provide drug coverage.
Because of all the different plan options and insurers, prescribing drugs to seniors has gotten more complicated for physicians, the authors noted.
Two-thirds of physicians in a previous survey said they lack familiarity with Part D drug lists, called formularies. And three-fourths of clinicians
Of the 72 drug plans offered in California examined in this study, researchers included stand-alone drug plans and Medicare Advantage, or HMO plans with a drug benefit.
Based on the National Ambulatory Medical Care Survey, the researchers looked at coverage for the top seven classes of drugs used by seniors, including heart medications, antidepressants, acid/peptic ulcer drugs, bloodglucose regulators, bone-loss drugs, anti-inflammatory drugs and diuretics.
Widely covered drugs were defined as being affordable and available, with a co-payment of $35 or less per prescription.
Formulary coverage was highest for the diuretics and beta blockers, at 90 percent and 85 percent respectively. Among ACE inhibitors, four out of 10 drugs were covered by at least 96 percent of the plans.
However, as few as 7 percent of formularies covered certain angiotensin receptor blockers, ARBs, to control high blood pressure. The research was conducted in the spring of 2006 using data supplied by Medicare. A follow-up review indicated that drugs that had since gone generic became more widely covered by the plans.
Nearly all the most-covered drugs were generic.
Still, physicians should not simply prescribe generics and assume they will be covered under most Part D plans, the authors noted. One-fourth of the 44 generic drugs studied were not widely covered.
"While encouraging use of generic drugs provides a partial answer, identifying widely covered drugs would be a better policy response to formulary variation," the authors wrote.
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