Medicare Part D: spending, beneficiary cost sharing, and cost-containment efforts for high-cost drugs eligible for a specialty tier : report to the ... on Ways and Means, House of Representatives.

By: Office, U. S. Government Accountability

"The Centers for Medicare & Medicaid Services (CMS) allows Part D plans to utilize different tiers with different levels of cost sharing as a way of managing drug utilization and spending. One such tier, the specialty tier, is designed for high-cost drugs whose prices exceed a certain threshold set by CMS. Beneficiaries who use these drugs typically face higher out-of-pocket costs than beneficiaries who use only lower-cost drugs.GAO was asked to provide information about high-cost drugs eligible for a specialty tier. This report provides information on these drugs including spending under Medicare Part D in 2007, the most recent year for which claims data were available; how different cost-sharing structures could be expected to affect beneficiary out-of-pocket costs; how negotiated drug prices could be expected to affect beneficiary out-of-pocket costs; and information Part D plan sponsors reported on their ability to negotiate price concessions and to manage utilization. GAO examined CMS data, including 2007 claims data, negotiated price and out-of-pocket cost data for selected drugs-including the 10 highest-utilization specialty tier-eligible drugs in 2007-and plans from 2006 through 2009, and formulary information provided to CMS by plan sponsors. GAO interviewed officials from CMS and 8 of..."

• Format: Paperback
• Language: English
• ISBN: 1974624625
• ISBN13: 9781974624621
• Release Date: January 1
• Publisher: Createspace Independent Publishing Platform
• Length: 44 Pages
• Weight: 0.28 lbs.
• Dimensions: 0.1" x 8.5" x 11.0"