Patient characteristics vary by class of drugs protected in Part D

The current Medicare Part D policy requires sponsors to cover, with a few exceptions, "all or almost all" of the six "protected" clbad of drugs: antidepressants, antipsychotics, anticonvulsants, immunosuppressants for the treatment of rejection transplantation, antiretrovirals and antineoplastics.¹ Overall, in 2016, 18 million Part D registrants took at least one drug in one of the six protected clbades, and total expenditures for drugs in the protected clbad accounted for 19% of the total. D component expenditures. In the proposed rule for Part D of CY 2020 Medicare, Medicare and Medicaid Service Centers (CMS) proposed to provide Part D sponsors with more tools such as: prior authorization and step therapy to manage forms in protected clbades.²

The effects of these proposed changes on patients will likely depend on the types of patients to whom prescribed medications have been prescribed. Manatt Health found considerable differences in patient characteristics among protected clbades in its badysis of the 2016 Part D drug event data. This suggests that the proposed changes could have very different impacts on patients. depending on the protected clbad that includes their drug treatment.

The number of registrants likely to be affected by the changes varies greatly from one clbad to the next.

• Antidepressants had the highest number of enrollees. More than 12.36 million Part D registrants used drugs of this clbad in 2016, compared with only 180,000 enrolled for immunosuppressants, the clbad with the lowest number of enrollees.

There is also a significant variance in the age of the patients.

• Antiretroviral patients tended to be younger than those taking antine- thrastics, with an average age of 57 versus 73, respectively.

Some clbades have a much larger user base among dual eligibility Part D registrants (those eligible for both Medicare and Medicaid).

• Double eligibles, measured by at least one month of dual eligibility in 2016, accounted for a larger proportion of people using antiretrovirals (68%) and antipsychotics (60%) than the other four protected clbades, including anticonvulsants (42%). %). ) and antidepressants (36%) to immunosuppressants (30%) and antineoplastics (26%).

The same variation can be observed in the use of clbad of protection drugs among those enrolled in Part D who qualify for Medicare due to disability.

• Just over two-thirds of registered individuals using antiretroviral drugs are currently eligible for Medicare due to disability. On the other hand, more than half of the enrollees meet the traditional health insurance criteria (old-age and survivors' insurance) for all other categories of drugs protected under Part D.

For five of the six protected clbades, 25% of Part D registrants who use drugs in the protected clbad accounted for 80% or more of total expenditures in each protected clbad.

• Specifically, 25% of registrants using antineoplastics accounted for 99% of antineoplastic expenditures; 25% of registrants using antipsychotics accounted for 93% of Part D expenses in this protected clbad. In contrast, 25% of enrollees using antiretrovirals accounted for 41% of expenditures in this protected clbad.

Patients using protected-clbad drugs were enrolled in Medicare Advantage Part-Part Plans (PDPs) and Part D Plans (MA-PDP plans) in similar proportions to the general Medicare population regardless of protected clbad. In 2016, about 60% of Part D enrollees were in PDPs and 40% in MA-PDPs.³

_{¹CMS. Medicare Prescription Drug Benefit Manual, Chapter 6, Section 30.2.5. Retrieved January 16, 2019 at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Part-D-Benefits-Manual-Chapter-6.pdf.}

_{²Fed. Reg. 83 (231). 62152. [November 30, 2018]. Accessed January 16, 2019 at https://www.govinfo.gov/content/pkg/EN-2018-11-30/pdf/2018-25945.pdf.}

_{³Kaiser Family Foundation (KFF). (2016). Medicare Part D in 2016 and trends over time. Retrieved January 16, 2019 from http://files.kff.org/attachment/Report-Medicare-Part-D-in-2016-and-Trends-over-Time.}