Report: Drug plans use sneaky tactics to deny seniors' meds
Prescription drug plans are using "restrictive tactics" to deny seniors refills of medications, and are not informing them of these practices, says a new report from Rep. Henry Waxman (D-CA).Those tactics include step therapy, volume limits and prior authorization requirements, according to the report, "Medicare Drug Plans: Restrictions on Access to Formulary Drugs." Step therapy requires patients try the plan's preferred, formulary drugs. Then if those drugs fail, they receive the medication of choice. Prior authorization requires either the patient or a physician to receive approval from the plan before getting coverage for a specific drug.
The average plan restricts access to more than 10% of the most popular drugs listed in its formulary, and some plans restrict access to more than 40% of the 100 most popular formulary drugs, the report said. The Pharmaceutical Care Management Association, a trade group representing pharmacy benefit managers, disputes findings in the report. Waxman is ranking minority member of the House Government Reform Committee.
For more on the report, go to http://www.democrats.reform.house.gov/story.asp?ID=1028.