Medicare Part D: Spending, Beneficiary Cost Sharing, and Cost-Containment Efforts for High-Cost Drugs Eligible for a Specialty Tier

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DIANE Publishing, 2010 - 43 pages
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The Centers for Medicare and Medicaid Serv. (CMS) allows Part D plans to utilize different tiers with different levels of cost sharing as a way of managing drug utilization and spending. One such tier, the specialty tier, is designed for high-cost drugs (HCD) whose prices exceed a certain threshold. Beneficiaries who use these drugs typically face higher out-of-pocket costs than those who use only lower-cost drugs. This report provides info. about HCD eligible for a specialty tier incl. spending under Medicare Part D; how different cost-sharing structures could be expected to affect beneficiary out-of-pocket costs; how negotiated drug prices could be expected to affect beneficiary out-of-pocket costs; and Part D plan sponsors ability to negotiate price concessions. Illus.

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