Part D Preserves Access to Medicines for Beneficiaries with Diabetes

Part D Preserves Access to Medicines for Beneficiaries with Diabetes

06.12.13 | By

The Annals of Internal Medicine recently published a study that compared prescription diabetes medicine use between Medicare Part D and the Veterans Affairs (VA) program, specifically focusing on generic drug use. The study and subsequent media coverage overlook some important facts about prescription drug coverage in these two programs.

The primary reason the VA is able to generate high rates of generic utilization is due to the fact that they restrict access to innovative medicines.  The VA uses a single national formulary, which includes coverage for a limited range of available prescription therapies.  In order for a medicine to be covered by the VA, providers may be required to substitute a generic alternative that is available in the same therapeutic class, but is not identical to the prescribed brand name medicine.  While generics play a key role in our system, no two people respond the same to medicine, making choice important to achieving the best possible health outcomes. Research shows that a variety of factors—such as genetic variation, age, the complexity of disease, and the number of other conditions a person has—cause patients to respond differently to medicines.  It is important that patients and physicians have access to a wide range of treatment options, so they can select those that most effectively meet individual medical needs. 

In contrast, Part D provides beneficiaries with a variety of plans to choose from and allows patients to get prescription medications at an affordable price.  A 2012 survey showed that roughly 3.3 million veterans, or 42 percent of VA enrollees, have supplemented their VA drug coverage with Part D or private insurance and the trends are increasing.  And of the most routinely prescribed medications for seniors, 93 percent were covered by two of the most popular Part D plans versus only 67 percent in the VA formulary.

As we’ve mentioned in the past, Part D continues to be a tremendous success for patients and the Medicare system overall.  Ninety four percent of beneficiaries report that they are satisfied or very satisfied with their Medicare Part D coverage.  The average monthly premium is about $30 this year – remaining virtually unchanged for the past three years and now 50 percent lower than initial projections. In fact, the Congressional Budget Office has reduced its 10-year Part D projection by over $100 billion in each of the last three years. The Centers for Medicare and Medicaid Services have noted that much of this is due to the high level of generic utilization. In 2012, four out of five prescriptions filled by Part D beneficiaries were for generic drugs.

The fact that VA beneficiaries have to supplement their plans with Part D speaks volumes and is illustrative of how restrictive VA prescription coverage really is.

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