MCOs Offering Both Medicare Advantage and Part D Plans are More Than Twice as Likely to Cover Avastin and Herceptin as a Drug Benefit on Their Medicare Advantage Plans

NASHVILLE, Tenn. and Glen Rock, N.J., July 29 /PRNewswire/ --HealthLeaders-InterStudy and Fingertip Formulary find that surveyed pharmacy directors whose managed care organizations offer both a Medicare Advantage (MA) and a Part D plan were more than twice as likely to cover Roche/Genentech/Chugai's Avastin and Herceptin for the treatment of multiple cancer indications as a drug benefit on their MA plans as on their stand-alone Part D plans. According to the new Formulary Forum report entitled Formulary Advantages Among Monoclonal Antibodies in Oncology: Health Plans Report High Priority on Reducing Oncology Drug Costs, this finding suggests some health plans shied away from Part D coverage of these drugs because of their high costs. Instead, the bulk of Part D coverage for these drugs likely comes from pharmacy benefit managers who offer stand-alone Part D products.

The report also finds that over the past year, surveyed national health plans have started moving coverage of Avastin and Herceptin from the medical benefit to the pharmacy benefit, increasing cost-sharing to beneficiaries while improving claims-tracking capabilities. A drug covered under the medical benefit could feature a copay, or set dollar amount, while a drug covered as a pharmacy benefit may include coinsurance, which represents a percentage of costs that must be paid by the beneficiary, thereby shifting more costs onto the patient.

"An FDA advisory committee recently recommended that the breast cancer label for Avastin be removed. While the use of Avastin for the treatment of breast cancer will likely fall dramatically, we do not expect its reimbursement to be adversely affected because of its established efficacy in other tumor types," said Senior Market Analyst Roy Moore.

About Formulary Advantages Among Monoclonal Antibodies in Oncology

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of MAbs in oncology, drivers of these trends and how stakeholders can capitalize on future shifts in coverage to steal share from the competition and provides insight for stakeholders looking to capitalize on future shifts in coverage in order to better position their products among competitors.

About Fingertip Formulary

Fingertip Formulary (www.FingertipFormulary.com), the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. Fingertip Formulary is a Decision Resources, Inc. company.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Both HealthLeaders-InterStudy and Fingertip Formulary are Decision Resources, Inc. companies. Please visit Decision Resources, Inc. at www.DecisionResourcesInc.com.

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SOURCE HealthLeaders-InterStudy; Fingertip Formulary