Medicare Monday: New research reveals Part D coverage is more robust than VA coverage for new, innovative medicines

Allyson Funk   |     September 12, 2016   |   SHARE THIS


For 10 years, Medicare Part D has successfully provided access to affordable prescription drug coverage to seniors and people living with disabilities thanks to robust competition and negotiation within the program. Despite the program’s success, some policymakers are advocating for changes that would allow the government to set prices in Part D, similar to how the Veterans Affairs (VA) program works, eliminating direct negotiation between Part D plan sponsors and pharmaceutical manufacturers.

A new analysis released by Xcenda compares the coverage of new, innovative medicines in Medicare Part D and the VA program. The comparison offers insight into how government price setting could affect coverage and access in the Part D program.  

For the analysis, Xcenda compared coverage of 25 first-in-class medicines from 2011 to 2015, using five drugs from each year of the study ranked by utilization. The results showed that VA covered far fewer innovative medicines than Medicare Part D.

According to the analysis, on average, Part D plans covered 81 percent of the 25 first-in-class medicines. Eleven medicines were covered by all Part D plans. In comparison, VA coverage was substantially lower, only covering three of the 25 medicines. These three medicines were widely covered by Part D plans, with 70 to 100 percent of plans providing coverage.  

The study suggests the implementation of a government price setting in Part D, similar to the VA, could limit access to the latest, most innovative medicines in Part D. Protection of the Medicare Part D program is important to ensure these lifesaving treatments continue to remain available to seniors and individuals living with disabilities.

See previous research on the differences in coverage between the VA and Part D here and how many VA enrollees supplement their coverage with Part D or                          
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Learn more about Medicare Part D here.



Allyson Funk

Allyson Funk Ally is a former senior director of public affairs at PhRMA focused on advocacy issues for the biopharmaceutical industry. Her expertise includes Medicare, Medicaid, 340B, health reform and more. Prior to PhRMA, her experience included leading health communications for a large membership organization, supporting public affairs clients and working for the governor of Louisiana.

Topics: Part D, Medicare, Medicare Monday

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