Fierce Healthcare March 7, 2024
Utilization management in Medicare Part D has become more restrictive over the last decade, even when compared to Medicare Advantage prescription drug plans, according to a new study.
The study, conducted by researchers at the University of Southern California and Blaylock Health Economics and published this week in Health Affairs, found an increase across multiple types of utilization management, including prior authorization, step therapy and formulary exclusions, between 2011 and 2020.
On average, 31.9% of drugs were restricted in some fashion in 2011, which grew to 44.4% by 2020, according to the study. By the end of the study window, 44.7% of formularies restricted brand-name-only drugs.
“Increasing reliance on formulary exclusions, a particularly blunt tool for restricting patients’ access to...
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