Exhibit 1. Medicare Part D Costs And Utilization For Drugs Used To Treat Hepatitis C
| Drug | Cost per claim 2014 | People treated, 2014 | Total cost, 2014 (millions) |
| Harvoni | $32,106 | 11,700 | $700 |
| Sovaldi | $28,360 | 33,000 | $3,121 |
| Olysio | $22,553 | 12,600 | $835 |
| TOTAL | 57,400 | $4,655 |
How much does Medicare spend on hepatitis C drugs?
Objectives: The recent arrival of new hepatitis C virus (HCV) drugs has brought fiscal pressures onto Medicare Part D; spending on HCV drugs in Part D jumped from $283 million in 2013 to $4.5 billion in 2014. We examined the current benefit designs for HCV drugs in Part D plans and analyzed patients' financial burden for those drugs.
Does Medicare Part D cover HCV drugs?
In 2019, Medicare Part D spent approximately $2.5 billion for hepatitis C drugs to treat 50,000 beneficiaries with the disease. Three drugs—Harvoni, Epclusa, and Mavyret—accounted for 93 percent of expenditures, with annual Medicare costs ranging from $28,000 to $77,000 per beneficiary. A portion of these totals was shared by Medicare beneficiaries who faced …
Does Medicare cover hepatitis C screenings?
May 03, 2016 · Results: HCV HCV For enrollees with no subsidy, the mean out-of-pocket spending needed to complete a course of treatment is substantial, ranging from $6297 to $10,889. $10.80 and $1191. drug users...
What determines the cost of a Medicare Part D plan?
Methods: Hepatitis C was used as a case study to compare the list prices, clinical merits, and preferred drug coverage frequency of select pan-genotypic direct acting agent Hepatitis C treatments. The treatments were then put through a hypothetical 2018 Medicare Part D standard cost structure to illustrate differences in out-of-pocket costs to ...
What is the cost of Hep C treatment?
A 2018 study found that a single pill of one hepatitis C drug cost $1,000. The total was $84,000 for its 12-week course of treatment. Another drug cost $23,600 per month. That's for treatment that could take 6 months to a year.Jun 26, 2020
Does Medicare cover Hep C shot?
You need all 3 shots for complete protection. Medicare also covers a one-time Hepatitis C screening test if your primary care doctor or practitioner orders it and you meet one of these conditions: You're at high risk because you use or have used illicit injection drugs.Jul 26, 2019
How can I get Hep C medication for free?
Patient assistance programs (PAPs) offer free hepatitis C drugs to lower-income people who are uninsured or underinsured, and who do not qualify for insurance programs such as Medicaid or Medicare.
Would Medicare Part D be considered a prescription drug benefit?
Medicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare, provided through private plans approved by the federal government.Oct 13, 2021
Are hepatitis A vaccines covered by Medicare?
Generally, Medicare Part D (prescription drug coverage) covers Hepatitis A shots when medically necessary. Medicare Part B (Medical Insurance) covers Hepatitis B shots, which usually are given as a series of 3 shots over a 6-month period (you need all 3 shots for complete protection).May 7, 2019
Does Medicare pay for hepatitis?
Medicare covers an HBV screening if your primary care doctor orders one and you meet one of these conditions: You're at high risk for HBV infection.
Are hep C drugs expensive?
Hepatitis C drugs are pricey Antiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000.Feb 5, 2019
Does insurance cover hep C drugs?
Not all health insurance plans cover all prescribed medications for HCV treatment with few exceptions. Most insurers cover Sovaldi. It has an estimated copay of $75 to $175 per month. Check with your insurance provider to see what your individual coverage may entail.
Will you always test positive for hep C?
A reactive or positive antibody test means you have been infected with the hepatitis C virus at some point in time. Once people have been infected, they will always have antibodies in their blood. This is true if they have cleared the virus, have been cured, or still have the virus in their blood.
Who has the cheapest Part D drug plan?
SilverScript Medicare Prescription Drug Plans Although costs vary by zip code, the average nationwide monthly premium cost of the SmartRX plan is only $7.08, making it the most affordable Medicare Part D plan on the market.
What drugs are not covered by Medicare Part D?
Medicare does not cover:Drugs used to treat anorexia, weight loss, or weight gain. ... Fertility drugs.Drugs used for cosmetic purposes or hair growth. ... Drugs that are only for the relief of cold or cough symptoms.Drugs used to treat erectile dysfunction.More items...
What is the most popular Medicare Part D plan?
Best-rated Medicare Part D providersRankMedicare Part D providerMedicare star rating for Part D plans1Kaiser Permanente4.92UnitedHealthcare (AARP)3.93BlueCross BlueShield (Anthem)3.94Humana3.83 more rows•Mar 16, 2022
What is Medicare Part D?
Medicare Part D provides outpatient prescription drug coverage to the elderly and disabled. It is delivered through private plans, including standalone prescription drug plans (PDPs) or Medicare Advantage plans with prescription drug coverage (MA-PDs). Medicare specifies a standard Part D benefit package, but plans can modify the benefits as long as their schemes are equal in value to the standard package.
What drugs did Part D cover?
All Part D plans covered 2 new HCV drugs, Olysio and Sovaldi, and 98% of plans covered Harvoni ( ). Only 33% of MAPDs and 30% of PDPs covered Viekira Pak. Nearly every plan that covered these new drugs used prior authorization and nearly half of the plans used quantity limits. Almost all plans placed new HCV agents in a specialty tier and required coinsurance rather than co-payment. The average coinsurance rate was slightly higher among MAPDs than PDPs (31.4% vs 28.7%), but it varied more among MAPDs (20%-50%) than PDPs (25%-33%).
How many people in the US have HCV?
More than 3 million Americans are infected with HCV, with its prevalence concentrated among baby boomers, who were born between 1945 and 1965. 7 HCV causes more deaths in the United States than HIV/AIDS. 8 Chronic HCV is a cause of serious and costly liver diseases, such as cirrhosis and liver cancer, and related hospitalizations and costs have increased during the past decade. 9 Although the burden of HCV can be reduced through screening and treatments, the implementation of recommended screening is limited, and half of the infected population goes undiagnosed. 9
Does Part D insurance cover HCV?
Part D plans charge relatively high coinsurance for new HCV drugs, and they require rigorous utilization management, including prior authorization and quantity limits for those drugs. Little variation in coverage exists across plans, leaving few options for beneficiaries to choose a plan with better benefits.
Hepatitis C Drugs Have Driven Drug Spending Upward
In November and December 2013, the FDA approved Olysio and Sovaldi, the first drugs in a new class of drugs to treat hepatitis C. Two other combination drugs (Harvoni and Viekira Pak) gained approval in 2014, and more hepatitis C drugs entered the market in 2015 and 2016.
Use Of Hepatitis C Drugs By Medicare Part D Enrollees And Medicare Spending
Two years ago, we analyzed data from the National Health and Nutrition Survey to estimate that 350,000 Medicare beneficiaries have hepatitis C, with fewer than half of them aware they had the viral infection. Using that baseline, we presented two scenarios.
Policy Implications
The good news for Medicare and beneficiaries is that hepatitis C can now be cured, with relatively few side effects and with a drug regimen that is needed for a short period of time.
What is Medicare Part C?
Part C. Medicare Part C is also known as Medicare Advantage. This is a combination Medicare plan where a private insurance company provides your Medicare benefits. Medicare requires that all Advantage plans cover at least the same benefits as original Medicare (parts A and B).
What is a Medigap plan?
Medigap. Medigap, or Medicare supplement insurance, is a plan that helps you reduce out-of-pocket costs if you have original Medicare. While there are different plans available, they generally help pay for costs like coinsurance and premiums for parts A and B, as well as foreign travel emergency care and more.
Does Medicare require a Part D plan?
Medicare requires that all individuals who are eligible for Medicare have a Part D plan or other creditable prescription drug coverage . These plans will usually have a formulary that separates drugs into different tiers based on cost.
Can hepatitis C cause liver problems?
Hepatitis C is a virus that can cause a long-term infection in the body that especially affects the liver. Some people are exposed to hepatitis C and the body clears the infection on its own. Other people can experience an acute illness and lifelong infection that leads to liver complications.
What is hep C?
What is hepatitis C? According to the National Institutes of Health, hepatitis C (also known as hep C) is inflammation (swelling) in the liver caused by a virus. Some people might respond well to hepatitis C treatment, but many people don’t, and can have the disease for years.
What is Medicare Advantage?
Enroll in a Medicare Advantage Prescription Drug plan, which offers at least the same benefits as Original Medicare (except hospice) and includes prescription drug coverage. Both types of plans are available through Medicare-approved private insurance companies.
Does Medicare cover prescription drugs?
Original Medicare doesn’t cover most prescription drugs except in limited inpatient and outpatient settings. For example, if you’re hospitalized, Medicare Part A usually covers prescription drugs that are part of your inpatient treatment. Under Part B, Medicare generally covers certain types of prescription drugs you get in an outpatient setting ...
How long does it take to cure hepatitis C?
Current treatments include oral medication, sometimes called direct-acting antivirals. These medications can be taken for approximately 8-12 weeks with a 90% rate of curing Hepatitis C.
How long does it take for hepatitis C to develop?
Most cases of Hepatitis C develop into a longer and possibly lifelong condition.
Does Medicare cover hepatitis C screening?
Medicare will cover the cost of one screening for Hepatitis C if you meet the following criteria: You are high risk due to illicit injected drugs. You had a blood transfusion before 1992. You were born between 1945 and 1965. If you’re considered high risk, Medicare will cover yearly screenings.
