Top line:
Among cancer patients, Medicare Advantage and Medicare Part D prescription drug plans frequently used prior authorization for cancer patients. ondansetron And low-cost antiemetics often had quantity limits. Even though ondansetron is more affordable in Medicare Advantage plans, both plan types charge significantly higher prices than Cost Plus Drug Company.
Methodology:
- Almost 80% of Medicare beneficiaries in the United States receive prescription drug benefits through Medicare Part D or Medicare Advantage, and these plans have offered the drug even though it has been available as a low-cost generic drug since 2006. Administrative tools may be in use that prevent patients from accessing ondansetron.
- This cross-sectional study examined the use and cost of oral ondansetron management tools across both plan types and included data from the Centers for Medicare and Medicaid Services database for Q3 2023, including 813 Part D and 3512 We looked at Medicare Advantage prescription drug plans.
- Researchers analyzed pre-approval requirements, quantity limits, and plan-level costs for 30-day supplies (90 units) of 4 mg tablets, 8 mg tablets, and orally disintegrating tablets.
- The researchers also compared prices to Mark Cuban Cost Plus Drug Company, a direct-to-consumer pharmacy with fixed markup prices.
remove:
- Medicare Advantage prescription drug plans used significantly more prior authorizations (90.3% vs. 71.9%) and quantity limits (22.5% vs. 16.5%) than Part D prescription drug plans (both). P < .001).
- Compared to Part D plans, Medicare Advantage plans offer significantly lower total costs for both 4 mg ondansetron tablets ($24.40 vs. $31.40) and 8 mg ondansetron tablets ($31.5 vs. $35.7). However, the cost of orally disintegrating tablets was similar.
- However, both Medicare plans charged significantly higher prices than Mark Cuban Cost Plus drug company prices for all formulations (e.g., $9.50 for 4 mg tablets; $9.50 for 8 mg tablets). ).
actual:
Despite the declining cost of ondansetron, most Medicare Advantage and Part D prescription drug plans continue to impose “substantial utilization controls, limiting timely patient access.” Meanwhile, the administrative burden on clinicians is increasing,” the authors write. “Policymakers must prioritize access to high-cost medicines to prevent unnecessary delays and costs in treatment.”
sauce:
The study was led by Changchuan Jiang, MD, MPH, of the University of Texas Southwestern Medical Center in Dallas; Published online in JAMA network open.
Limitations:
The use of plan-level data limited analysis of individual patient outcomes and prevented insight into the real-world impact of these policies.
Disclosure:
Both authors were supported by grants from the University of Texas Southwestern Medical Center and the National Cancer Institute. Several authors reported receiving grants or personal fees and having other connections with various sources.
This article was created using several editing tools, including AI as part of the process. A human editor reviewed this content before publication.
