Cost-Sharing Under Medicare Part D

Private provision of social insurance: drug-specific price elasticities and cost sharing in Medicare Part D

We explore how private drug plans set cost-sharing in the context of Medicare Part D. While publicly-provided drug coverage typically involves uniform cost-sharing across drugs, we document substantial heterogeneity in the cost-sharing for different drugs within privately-provided plans. We also document that private plans systematically set higher consumer cost sharing for drugs or classes ass...

Cost variability of suggested generic treatment alternatives under the Medicare Part D benefit.

BACKGROUND The substitution of generic treatment alternatives for brand-name drugs is a strategy that can help lower Medicare beneficiary out-of-pocket costs. Beginning in 2011, Medicare beneficiaries reaching the coverage gap received a 50% discount on the full drug cost of brand-name medications and a 7% discount on generic medications filled during the gap. This discount will increase until ...

High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia.

OBJECTIVES Specialty drugs often offer medical advances but are frequently subject to high cost sharing. This is particularly true with Medicare Part D, where after meeting a deductible, patients without low-income subsidies (non-LIS) typically face 25% to 33% coinsurance (initial coverage phase with "specialty tier" cost sharing), followed by ~50% coinsurance (coverage gap phase), and then 5% ...

Billing for Medicare Part D vaccines.

Y ou are probably familiar with the coding and billing process for the limited number of preventive vaccines that Medicare has traditionally covered under Part B (i.e., influenza, pneumococcal and hepatitis B). With the advent of the new herpes zoster (shingles) vaccine and its coverage under Medicare Part D, this familiar routine has been interrupted. Here’s what you need to know to get pai...

Medicare. Part D: Prescription drug coverage.