Patients were required to spend more out of pocket for a substantial proportion of Medicare’s prescription drug plans compared with Walmart’s generic drug discount program for 30-day supplies of generic medications used to treat prevalent CVD-related conditions, according to a research letter published in Annals of Internal Medicine.
Researchers from Yale School of Medicine compared out-of-pocket costs under several Medicare prescription drug plans (PDPs) vs. Walmart’s generic drug discount program (GDDP).
“To control expenditures, health plans are increasingly shifting costs to patients. Greater out-of-pocket expenses may adversely affect patients’ medication adherence and subsequent health outcomes,” the researchers wrote. “GDDPs, including one from Walmart, were started in 2006 and sell many commonly used generic medications for $4 per 30-day supply regardless of insurance status and may lead to patient savings.”
The analysis involved 1,533 Medicare Advantage PDPs (MA-PDPs) and 622 standalone PDPs. From Walmart’s GDDP list, researchers identified 27 generic medications used for prevalent CVD-related conditions. Of 27 medications. Medicare PDPs covered a median of 25 medications. According to the researchers, across all medications and tiers, the median proportion of plans that required patients to spend more than $4 out of pocket for covered medications was 21%.
According to the researchers, the median total out-of-pocket cost of covered medications across all tiers was $2 (IQR, $0-5), and costs differed significantly between MA-PDPs and PDPs for medications covered in tier one and select care tiers (median cost, $2 vs. $1) and for medications covered in other tiers (median cost, $10 vs. $3).
“In particular, MA-PDPs consistently required patients to spend more out of pocket than standalone PDPs, a counterintuitive finding considering that MA plans are responsible for acute-care coverage, outpatient services and other health care expenses for their beneficiaries and not solely pharmaceutical services like standalone PDPs,” the researchers wrote. – by Jake Scott
The authors report no relevant financial disclosures.