HealthPocket® released a study of 2018 Medicare Part D and Medicare Advantage plans that revealed the difficulties facing Medicare beneficiaries when trying to find the most extensive specialty drug coverage. Specialty drugs can be very expensive, some costing thousands per month retail, and these drugs have become an ever-increasing portion of U.S. spending on prescription medications. While Medicare drug plans can reduce those costs when a prescribed specialty drug is “on formulary” (i.e. included within the insurance plan’s list of covered drugs), specialty drugs excluded from an insurance plan’s formulary leave enrollees facing full retail price and with no prospect of relief from Medicare’s “catastrophic coverage” provision. Medicare beneficiaries in this situation can petition a plan for a formulary exception but exception approval is not guaranteed and enrollees must still wait for the next enrollment period normally to find a new insurance plan with the drug covered.
For Medicare beneficiaries worried about the potential costs of specialty drugs should they need them, finding a plan with the most extensive coverage of this medication category is not an easy task. HealthPocket examined government data on 2018 Medicare Part D and Medicare Advantage plans and found that specialty drug coverage varied widely within both categories of Medicare drug insurance plans.