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Medicare Part D favours generics over brand-name drugs Posted 23/10/2020

A recent assessment of Medicare Part D [1] finds that insurance plans favour generic drugs over innovator products. Fewer than 1% of plans covered only the brand-name version of a drug in 2019.

Medicare Part D is an optional programme to help Medicare beneficiaries to pay for their prescription drugs.

Although some recent press reports suggest Medicare Part D plans encourage the use of brand-name drugs, a recent evaluation [1] finds that the plans in fact rarely cover originator drugs when generics versions are available.

The study examined Medicare Part D formulary coverage and tier placement of more than 1,360 matched pairs of brand-name drugs and generics in order to quantify how often brand-name drugs are preferred in Part D plans.

The results show that, in 2019, the vast majority (84%) of Part D plan-product combinations only covered generics. A further 15% covered both the brand-name and generic versions of a drug.

Although brand-name versions were preferentially covered in a small number of cases (0.9%), beneficiary and Medicare prices were generally low for both the brand-name and generic version of the drug.

Lead author of the study Dr Stacie Dusetzina said: ‘What our study found is, in fact, that Part D plan formularies are designed to favour generics much more often than the brand-name counterpart, which, in the end, saves patients money’.

Overall, the findings show that most Part D plan formularies encourage the use of generics. The authors say policymakers should continue to monitor Part D formulary coverage to ensure that this remains the case.

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Reference
1. Dusetzina SB, Cubanski J, Nshuti L, et al. Medicare Part D Plans Rarely Cover Brand-Name Drugs When Generics Are Available. Health Aff (Millwood). 2020;39(8):1326-33.

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