75% of Cancer Drugs Are Covered Under Medicare Prescription Drug Benefit Plans, Study Finds

Medicare prescription drug plans cover 75% of cancer drugs, according to study conducted by Avalere Health and published in the September/October issue of Health Affairs, Dow Jones reports. The study examines CMS data from January and February on 3,000 Medicare PDPs (Gerencher, Dow Jones, 9/18). Researchers focused on two classes of cancer drugs called anti-neoplastics and hormonal agents. They did not examine data on infused chemotherapy drugs, drugs used mainly for cancer supportive care or oral cancer drugs covered by Medicare Part B (Bowman et al., Health Affairs, September/October 2006). Under the 2003 Medicare law, Medicare PDPs are required to cover "all or substantially all" anti-neoplastics. Lead author Jennifer Bowman, director in the Medicare practice at Avalere Health, said the study finds that the drug plans cover 99% to 100% of generic cancer drugs and about 70% of brand-name cancer drugs. She added, "Brands are covered less frequently than generics, but it turns out brands that were not covered almost always had a generic equivalent available." For example generic tamoxifen is covered by 100% of stand-alone prescription drug plans and nearly 100% of integrated drug plans, but Nolvadex -- the brand-name for tamoxifen -- is covered by 29% of plans, Bowman said. In addition, the study finds that copayments for 30-day supplies of cancer drugs range from $5 to $40. Tarceva has a $40 copay, the highest median copay of the drugs studied. Bowman said. The study also finds that 10% of drugs require prior authorization, 5% of all PDPs limit quantities of medications and no plans require step therapy, in which patients must first try lower-priced drugs before receiving coverage for more expensive treatment, Bowman said. The study did not examine beneficiaries' access to drugs during the so-called "doughnut hole" coverage gap (Dow Jones, 9/19). An abstract of the study is available online.