decisionhealth Newsletters, Part B News - 2022 Issue 8 (August)
Part D plan preference for higher-cost hepatitis C drugs led to higher Medicare and beneficiary spending
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Article Overview
This article covers an OIG review of hepatitis C drug utilization in Medicare Part D versus Medicaid across 2019 and 2020. It explains why the review was conducted, the broad findings about differences in generic uptake and spending, and the resulting CMS/OIG policy discussion. The article is relevant to Medicare Part D stakeholders, pharmacy and compliance professionals, and readers tracking drug coverage, access, and federal program spending.
Why This Topic Matters
It highlights how plan coverage choices and broader program factors can affect beneficiary out-of-pocket costs and Medicare spending, especially when lower-cost alternatives are available. The findings and CMS response may be relevant to formulary access discussions and policy oversight.
What You Will Learn
- How an OIG review compared hepatitis C drug use across Medicare Part D and Medicaid
- What broad spending effects were identified for beneficiaries and Medicare
- Why generic drug access and plan coverage decisions are being discussed at the federal level
- How CMS responded to the OIG’s recommendations
Who Should Read This
- Medicare Part D plans
- Compliance professionals
- Pharmacy benefit stakeholders
- Healthcare policy analysts
- Coding and reimbursement professionals
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