The number of drugs available and the restrictions for coverage vary widely among Medicare prescription drug plans, according to an analysis by HealthPocket in Sunnyvale, Calif., an online company that ranks and compares health insurance plans.
Among stand-alone prescription drug plans, the number of available drugs range from 956 to 2,334. Among Medicare Advantage plans with drug benefits, the number ranges from 995 to 2,333.
About 90 percent of Medicare enrollees have some form of drug benefit. Each drug plan has a formulary that lists which drugs are covered and how much the consumer is responsible for paying out of pocket for medications. Consumers must pay the full cost for drugs that aren't listed on the formulary. Even if a drug is on the formulary, a health plan can restrict access to it by limiting the quantity, requiring prior authorization or mandating a step therapy process.
Some plans put very few restrictions on access, while others put restrictions on roughly a third of the drugs on their formularies.
"The lesson here for Medicare patients is that they really need to do their homework during open enrollment season to figure out which plans give them the best deal," said Steve Zaleznick, Health Pocket's executive director for consumer strategy and development, in a press statement. "The most important question for consumers is if the drugs they take are on the plan's formulary, and the next is what hoops they may have to jump through to actually get the drugs in hand."
Medicare beneficiaries have until Dec. 7 to make any changes to their drug plans for 2014.