Medicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence in WA.
OBJECTIVE
Pharmacotherapeutic treatments for drug addiction offer new options, but only if they are affordable for patients. The objective of this study is to assess the current availability and cost of five common antiaddiction medications in the largest federal medication insurance program in the US, Medicare Part D.


METHODS
In early 2010, we collected coverage and cost data from 41 Medicare Part D prescription drug plans (PDPs) and 45 Medicare Advantage Plans (MAPs) in Washington State.


RESULTS
The great majority of Medicare plans (82-100%) covered common pharmacotherapeutic treatments for drug addiction. These Medicare plans typically placed patent protected medications on their highest formulary tiers, leading to relatively high patient co-payments during the initial Part D coverage period. For example, median monthly co-payments for buprenorphine (Suboxone®) were about $46 for PDPs, and about $56 for MAPs.


CONCLUSIONS
While Medicare prescription plans usually cover pharmacotherapeutic treatments for drug addiction, high co-payments can limit access. For example, beneficiaries without supplemental coverage who use Vivitrol® would exceed their initial coverage cap in 7-8 months, reaching the "doughnut hole" in their Part D coverage and becoming responsible for the full cost of the medication (over $900 per month). The 2010 Patient Protection and Affordable Care Act will gradually eliminate this coverage gap, and loss of patent protection for other antiaddiction medications (Suboxone® and Campral®) should also drive down patient costs, improving access and compliance.
Department of Health Policy and Administration, Washington State University, Spokane, WA 99210, USA. jjkennedy@wsu.edu
Jae
J
Kennedy
Aaron
A
Dipzinski
John
J
Roll
Joseph
J
Coyne
Elizabeth
E
Blodgett
D000437:Alcoholism / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D006278:Medicare / Q000191:economics; D054524:Medicare Part D / Q000191:economics*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D055553:Prescription Drugs / Q000191:economics* / Q000627:therapeutic use; D014481:United States; D014861:Washington / Q000453:epidemiology
D055553:Prescription Drugs