Medicare Part D Protected-Class Policy Is Associated With Lower Drug Rebates

Health Affairs October 1, 2024
Pragya Kakani, Michael Anne Kyle, Amitabh Chandra, Luca Maini

Abstract

Medicare Part D does not allow plans to exclude drugs in six protected classes from their formularies, which may limit plans’ ability to negotiate rebates and lead to higher spending. We estimated the association between protected-class status, US-level estimated rebates, and formulary coverage during the period 2011–19. We found that protected classes indeed had significantly lower exclusion rates in Medicare Part D during this period relative to...

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