Medicare prescription drug customers should closely study 2011 coverage options before they renew their plans, according to the research firm Avalere Health, which forecasts significant changes in the coming year.
Many plans have changed the drugs they cover or the amounts consumers pay, and more plans are adding steps like prior authorization, Avalere said Tuesday in an analysis released to The Associated Press. That means a prescription a consumer filled with little hassle in 2010 may come with a different price or may not be covered in 2011.
"More and more every year (plans) change, and that's why it's important for people to shop around," Avalere CEO Dan Mendelson said.
Consumers have until Dec. 31 to sign up for Medicare Part D prescription drug coverage as a stand-alone plan or as part of Medicare Advantage plans, which are privately run versions of the government's Medicare program. People also can sign up for coverage when they reach age 65 or become eligible for Medicare.
Insurers base their prescription drug coverage on formularies, or lists of drugs covered by their plan. Avalere said a total of 1,109 plans will be offered next year, and 2,314 drugs will appear on at least one formulary. But the percentage of those drugs covered by each plan varies widely among the biggest stand-alone prescription drug plans.
Insurers also are adding more pricing tiers to their plans to steer customer toward cheaper drugs. Their systems traditionally involved three tiers, one for less-expensive generic drugs and then categories for preferred and non-preferred branded drugs. But Avalere found that a growing percentage of plans — 42 percent in 2011 compared to 27 percent in 2009 — now use five tiers.
The additional tiers can break down generic and specialty drugs into new categories, which enables the plan to charge higher prices for some branded drugs or generics that aren't widely used.
Some plans also are trimming the lists of drugs they cover, as branded drugs lose patent protection from generic competition. Mendelson noted that the heartburn drug Prevacid was dropped by UnitedHealth's AARP Medicare RX Preferred plan, the largest standalone Part D plan with enrollment estimated at more than 4 million people next year.
Avalere said that plan trimmed more than 600 drugs from its formulary, which will have 1,764 in 2011. But Mendelson noted that many of the dropped drugs have generic equivalents that are still covered so customers aren't left without options.
Medicare Part D coverage started in 2006, and change has been a constant for the formularies in those plans, according to Judith Stein, executive director of the Center for Medicare Advocacy, a Connecticut-based consumer group. She said consumers need to check how a plan covers the particular dose they need for their medicine and not just the medicine itself before they settle on coverage.
"You may find good buy in a size 8 shoe, but if you wear a size 9, it's of no use to you," said Stein, who was not involved with the Avalere study.
She recommends using the Web site https://www.medicare.gov/find-a-plan/questions/home.aspx to check out plans.