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Key Markets in Medicare Part D

Decision Resources
August 28, 2008
47 Pages - SKU: DECR1904351

Abstract Table of Contents Related Reports

Introduction

Medicare Part D, the outpatient prescription drug benefit introduced in January 2006, had an immediate impact on the U.S. pharmaceutical market and now accounts for almost one-fifth of prescription drug sales. Cardiovascular diseases, metabolic disorders, infectious diseases, immune/infl ammatory disorders, and several other key conditions account for a substantial share of Medicare Part D prescribing. This report, featuring 36 data-based figures and 15 statistical tables, examines health insurance and prescribing patterns in 2006 and 2007 for 16 key indications among the senior population. The report also examines Medicare Part D plans' coverage of best-selling drugs in these indications and assesses the outlook for the Medicare drug benefit.

Get the Answers You Need to Shape Your Strategy

Medicare Part D enrollment is forecast to grow from 27.1 million in 2006 to 60.1 million in 2030. How are employers responding to the introduction of the Medicare drug benefit? What are the implications of growing Medicare Part D enrollment for branded drug manufacturers?
In 2007, Medicare Part D provided prescription drug coverage for at least half of patients aged 65 or older in 15 out of 16 indications that are common in the senior population. In which indication did Medicare Part D fund drug treatment for a minority of senior patients? Which indications had the highest levels of Medicare Part D coverage?
Formulary positioning and utilization restrictions such as prior authorization and step therapy have a major infl uence on prescribing patterns. Which drugs have the most advantageous formulary placement? Which products are most commonly subjected to prior authorization or step therapy? What coinsurance and copayment strategies do Medicare Part D plans pursue?
The national elections in November 2008 will change the political environment for U.S. healthcare in general and the Medicare program in particular. What policies have the presumptive Democratic and Republican presidential candidates proposed for Medicare reform? How do they view the research-based pharmaceutical industry?

Scope

Market impact of Medicare Part D: program's share of the U.S. pharmaceutical market from 2006 through 2017 (projected); limited contribution to market growth.
Key Medicare Part D therapeutic areas: cardiovascular diseases; metabolic disorders; infectious diseases; immune/infl ammatory disorders; other conditions (cataracts, glaucoma, benign prostatic hyperplasia).
Coverage trends by therapeutic area: formulary positioning of leading brands; use of prior authorization and step therapy restrictions; coinsurance and copayment trends.
Outlook for Medicare Part D: sustained growth of the Medicare Population; regulatory reforms; changing political climate.

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Executive Summary: Strategic Considerations; Stakeholder Implications
Introduction
Methodology
Key Medicare Part D Therapeutic Areas: Cardiovascular Disorders; Metabolic Disorders; Infectious Diseases; Immune/Infl ammatory Disorders; Other Common Indications
Formularies and Medicare Part D: Medicare Part D Plans and Evolving Formulary Design; Coverage of Cardiovascular Drugs; Coverage of Metabolic Drugs; Coverage of Infectious Disease Therapies; Coverage of Immune/Infl ammatory Drugs; Coverage of Treatments for Other Common Indications
The Outlook for Medicare Part D: Sustained Growth of the Medicare Population; Regulatory Reforms; Changing Political Climate
Tables: 1. Select Brand-Name Cardiovascular Drugs with 2007 U.S. Sales; 2. Select Brand-Name Metabolic Drugs with 2007 U.S. Sales; 3. Select Brand-Name Anti-Infectives with 2007 U.S. Sales; 4. Select Brand-Name Immune/Infl ammatory Drugs with 2007 U.S. Sales; 5. Select Brand-Name “Other” Drugs with 2007 U.S. Sales; 6. Available Medicare Part D Formulary Coverage and Restrictions for Cardiovascular Drugs; 7. Available Medicare Part D Formulary Copay and Coinsurance Data for Cardiovascular Drugs; 8. Available Medicare Part D Formulary Coverage and Restrictions for Metabolic Drugs; 9. Available Medicare Part D Formulary Copay and Coinsurance Data for Metabolic Drugs; 10. Available Medicare Part D Formulary Coverage and Restrictions for Anti-Infectives; 11. Available Medicare Part D Formulary Copay and Coinsurance Data for Anti-Infectives; 12. Available Medicare Part D Formulary Coverage and Restrictions for Immune/Infl ammatory Drugs; 13. Available Medicare Part D Formulary Copay and Coinsurance Data for Immune/Infl ammatory Drugs; 14. Available Medicare Part D Formulary Coverage and Restrictions for “Other” Indication Drugs; 15. Available Medicare Part D Formulary Copay and Coinsurance Data for “Other” Indication Drugs
Figures: 1. U.S. Pharmaceutical Expenditures by Source of Funding, 2000-2017 (Projected); 2. Share of U.S. Pharmaceutical Expenditures by Source of Funding, 2000-2017 (Projected); 3. Medicare Benefi ciaries’ Sources of Prescription Drug Benefi ts as of January 2008; 4. Hypertension Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 5. Top Hypertension Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 6. Atrial Fibrillation Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 7. Top Atrial Fibrillation Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 8. Coronary Atherosclerosis Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 9. Top Coronary Atherosclerosis Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 10. Congestive Heart Failure Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 11. Top Congestive Heart Failure Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 12. Dyslipidemia Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 13. Top Dyslipidemia Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 14. Type 2 Diabetes Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 15. Top Type 2 Diabetes Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 16. Osteoporosis Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 17. Top Osteoporosis Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 18. Bronchitis Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 19. Top Bronchitis Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 20. Pneumonia Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 21. Top Pneumonia Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 22. Chronic Sinusitis Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 23. Top Chronic Sinusitis Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 24. Urinary Tract Infection Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 25. Top Urinary Tract Infection Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 26. Osteoarthritis Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 27. Top Osteoarthritis Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 28. Chronic Airway Obstruction Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 29. Top Chronic Airway Obstruction Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 30. Cataract Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 31. Top Cataract Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 32. Glaucoma Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 33. Top Glaucoma Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 34. Benign Prostatic Hyperplasia Patients, Aged 65 or Older, by Prescription Drug Insurance Type, 2006 and 2007; 35. Top Benign Prostatic Hyperplasia Drugs Prescribed to Medicare Part D Patients, Aged 65 or Older, 2006 and 2007; 36. Past and Projected Enrollment in the Medicare Program, 2006-2030

Key Markets in Medicare Part D

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