title: Coverage of atypical antipsychotics among medicare drug plans in the state of washington for fiscal year 2007.
abstract: OBJECTIVE
  To examine drug coverage and patient costs for 6 atypical antipsychotics (olanzapine, quetiapine, ziprasidone, aripiprazole, clozapine, and risperidone) in Medicare Part D formularies using health plan data from the state of Washington.
  
  
  METHODS
  Fiscal year 2007 coverage and cost-sharing characteristics for 57 prescription drug plans (PDPs) and 43 Medicare advantage prescription drug plans (MAPDs) were collected from the Centers for Medicare and Medicaid Services. Plans were compared in terms of formulary restrictions, out-of-pocket costs, and premium charges. Medicare released plan information for fiscal year 2007 in October 2006. Data were collected for this study in February 2007.
  
  
  RESULTS
  Almost all plans covered the 6 atypical antipsychotics. The PDPs were more likely to restrict coverage than the MAPDs. Prior authorization requirements were enforced in 5% to 21% of plans, depending on plan type and medication. Monthly drug plan premiums were higher for PDPs than MAPDs, but the MAPDs had concurrent monthly health premiums. About 80% of MAPDs and 60% of PDPs also had no annual deductible for medications. The patient out-of-pocket cost for atypical antipsychotics varied depending on the stage of coverage-median monthly drug costs ranged from $5 to $50 during the initial period, but if costs exceeded the annual cap, patients were responsible for the full cost of the drug, which ranged from $292 to $665. Patients with low incomes and those who exceeded the annual spending limit ($3850 in fiscal year 2007) had a median monthly cost of $17 to $33.
  
  
  CONCLUSIONS
  There is considerable variation across health plans in terms of patients' out-of-pocket drug costs. Given the significant needs and vulnerabilities of Medicare beneficiaries with mental illness, changes for atypical antipsychotic coverage should be monitored carefully, and the complexity of Medicare drug plans should be minimized.
authors.affiliation: Department of Pharmaceutical Sciences, Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA. chicwang@email.unc.edu
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wang
authors.forename: Jae
authors.initials: J
authors.lastname: Kennedy
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cohen
authors.forename: David A
authors.initials: DA
authors.lastname: Sclar
references.citation: N Engl J Med. 2005 Sep 22;353(12):1209-23
references.pmid: 16172203
references.citation: J Gen Intern Med. 2005 Jul;20(7):662-5
references.pmid: 16050866
references.citation: Am J Psychiatry. 2002 Sep;159(9):1534-40
references.pmid: 12202274
references.citation: Am J Manag Care. 1997 Feb;3 Suppl:S11-7
references.pmid: 10180337
references.citation: Schizophr Bull. 2006 Oct;32(4):715-23
references.pmid: 16540702
references.citation: Physician Exec. 2005 Jul-Aug;31(4):42-4
references.pmid: 16285169
references.citation: J Clin Psychiatry. 1998;59 Suppl 19:23-9
references.pmid: 9847049
references.citation: N Engl J Med. 2005 Dec 29;353(26):2733-5
references.pmid: 16382056
references.citation: J Clin Psychiatry. 2003 Jan;64(1):30-4
references.pmid: 12590620
references.citation: Am J Geriatr Cardiol. 2005 Nov-Dec;14(6):284-8; quiz 289-90
references.pmid: 16276124
references.citation: Value Health. 2006 Mar-Apr;9(2):77-89
references.pmid: 16626411
references.citation: Psychiatr Serv. 2005 Jun;56(6):645-7
references.pmid: 15939937
references.citation: Issue Brief Cent Medicare Educ. 2005;5(10):1-10
references.pmid: 15943013
references.citation: J Clin Psychopharmacol. 2003 Dec;23(6):660-4
references.pmid: 14624196
references.citation: Psychiatr Q. 2006 Winter;77(4):319-27
references.pmid: 16927163
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 1999 Jan;23(1):1-14
references.pmid: 10368852
references.citation: J Clin Psychiatry. 2003;64 Suppl 17:11-4
references.pmid: 14680421
references.citation: EBRI Issue Brief. 2004 Jan;(265):1-35
references.pmid: 14969223
references.citation: Arch Gen Psychiatry. 2006 Oct;63(10):1079-87
references.pmid: 17015810
references.citation: N Engl J Med. 2003 Dec 4;349(23):2224-32
references.pmid: 14657430
references.citation: Psychiatr Serv. 2007 Mar;58(3):308-10
references.pmid: 17325102
references.citation: Milbank Q. 2005;83(1):101-30
references.pmid: 15787955
references.citation: Med Care. 2004 Jul;42(7):626-34
references.pmid: 15213486