In 2019, Medicare Part D
Medicare Part D
Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums. Part D was originally propo…
Hepatitis
Inflammatory condition of the liver.
Ledipasvir/sofosbuvir
Ledipasvir/sofosbuvir, sold under the trade name Harvoni among others, is a medication used to treat hepatitis C. It is a combination of ledipasvir and sofosbuvir. Cure rates are 94% to 99% in people infected with hepatitis C virus genotype 1. Some evidence also supports use in HCV genoty…
Full Answer
How much does Medicare spend on hepatitis C drugs?
For enrollees with a low-income subsidy, out-of-pocket spending varies between $10.80 and $1191. Conclusions: Under the current Part D benefits, HCV drug users with no subsidy face sizable financial burdens, even with catastrophic coverage and the recent in-gap discount for brand name drugs.
How much does Medicare Part D drug coverage cost?
May 03, 2016 · This study analyzes the current coverage designs for hepatitis C virus drugs by Medicare Part D plans. ABSTRACT . Objectives: The recent arrival of new hepatitis C virus (HCV) drugs has brought...
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?
Even with Medicare coverage, medication treatments for hepatitis C can still be costly. According to a 2017 analysis, the cost could range from $6,297 to $10,889 for the entire treatment course....
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.
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.
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.
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 ...
The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019
Medicare Part D has helped to make prescription drugs more affordable for people with Medicare, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Specialty tier drugs—defined by Medicare as drugs that cost more than $670 per month in 2019—are a particular concern for Part D enrollees in this context.
Key Findings
Medicare Part D enrollees not receiving low-income subsidies can expect to pay thousands of dollars out of pocket for a single specialty tier drug in 2019 (Figure 1).