Coverage and prior authorization of psychotropic drugs under Medicare Part D.
This study examined formulary coverage and use of utilization management tools for three classes of psychotropic medications (antidepressants, antipsychotics, and anticonvulsants) among Medicare Part D prescription drug plans serving individuals dually eligible for the Medicare and Medicaid programs. Plans must cover "all or substantially all" molecules (distinct drugs) in these classes. Plans serving "dual eligibles" generally covered at least one formulation of all molecules in the three classes. However, certain product formulations were not covered by a number of plans, and use of prior authorization was common for a minority of plans. The effect of Part D will depend on the restrictiveness of the prior authorization and appeals processes, which is currently unknown.
Huskamp
Haiden A
HA
Department of Health Care Policy, Harvard Medical School, and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. huskamp@hcp.med.harvard.edu
Stevenson
David G
DG
Donohue
Julie M
JM
Newhouse
Joseph P
JP
Keating
Nancy L
NL
D000368:Aged; D019985:Benchmarking / Q000331:legislation & jurisprudence; D004608:Eligibility Determination; D005569:Formularies as Topic; D006801:Humans; D007345:Insurance Claim Review; D007356:Insurance, Pharmaceutical Services / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008484:Medicaid / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D016345:Medicare Part B / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000188:drug therapy* / Q000191:economics; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use*; D014481:United States
D011619:Psychotropic Drugs