{"id":22091,"date":"2021-03-11T16:26:42","date_gmt":"2021-03-11T21:26:42","guid":{"rendered":"https:\/\/avalere.com\/?p=22091"},"modified":"2024-05-08T14:10:50","modified_gmt":"2024-05-08T18:10:50","slug":"generic-drug-placement-on-part-d-generic-tiers","status":"publish","type":"post","link":"https:\/\/advisory.avalerehealth.com\/insights\/generic-drug-placement-on-part-d-generic-tiers","title":{"rendered":"Generic Drug Placement on Part D Generic Tiers Declines Again in 2021"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row][vc_column][vc_column_text]Medicare Part D plans have the flexibility to design drug formularies and structure tiers as long as they meet the formulary design requirements of the Centers for Medicare &amp; Medicaid Services (CMS). Since 2017, plans have had the option to include a greater proportion of generic drugs on the non-preferred tier if they replace the \u201cnon-preferred brand\u201d tier with a \u201cnon-preferred drug\u201d tier. <a href=\"https:\/\/advisory.avalerehealth.com\/insights\/for-the-first-time-a-majority-of-generic-drugs-are-on-non-generic-tiers-in-part-d\">Prior Avalere analyses<\/a> assessed the outcome of this policy change, finding that over time Part D plans have increasingly added more generic drugs from generic tiers onto the \u201cnon-preferred drug\u201d tier.<\/p>\n<p>This analysis from Avalere, which has been run annually and with the same methodology since 2016, again finds that Part D plan sponsors are increasingly placing generic drugs on higher tiers over time (Figure 1).[\/vc_column_text][vc_single_image image=&#8221;22089&#8243; add_caption=&#8221;yes&#8221; img_caption=&#8221;Figure 1. Distribution of Generic Drugs on Part D Formulary Tiers, 2016\u20132021 &#8221; css=&#8221;.vc_custom_1615473563387{margin-top: 50px !important;margin-bottom: 20px !important;}&#8221;][vc_column_text]At the same time, the proportion of generic products placed on non-generic tiers (i.e., any tier not designated specifically for generics) has increased over time (Figure 2). 2020 was the first year since the launch of the Part D program that generics were placed on non-generic tiers more often than on generic tiers, and this figure grew in 2021, with 55% of covered generic products now placed on non-generic tiers. This is a 19-percentage-point increase from 2016, when generic products were placed on non-generic tiers only 36% of the time.[\/vc_column_text][vc_single_image image=&#8221;22090&#8243; add_caption=&#8221;yes&#8221; img_caption=&#8221;Figure 2. Distribution of Generic Drugs on Generic and Non-Generic Tiers, 2016\u20132021 &#8221; css=&#8221;.vc_custom_1615473689335{margin-top: 50px !important;margin-bottom: 20px !important;}&#8221;][vc_column_text]Under Medicare Part D benefit design requirements, beneficiaries generally pay more cost sharing for drugs on higher tiers (i.e., Tiers 3 and 4) than those on lower tiers (i.e., Tiers 1 and 2). Therefore, when generic products are placed on non-generic tiers, patients often pay more out of pocket for these medications than if they were placed on generic tiers.<\/p>\n<p><em>Funding for this research was provided by the Association for Accessible Medicines. Avalere Health retained full editorial control.<\/em><\/p>\n<h2>Methodology<\/h2>\n<p>Avalere analyzed CMS public use files (PUFs) with Medicare Part D formulary and benefit design information for 2016\u20132021. The study used the brand\/generic indicator assigned to drugs in the formulary data. Part D plans name and define their tiers in a variety of ways. For consistency, this analysis aggregated different tier names into 6 tier categories: generic, preferred generic, preferred brand, non-preferred brand, non-preferred drug, and specialty. For all years, Avalere used actual plan formulary design and tiering information for generic drugs from the CMS\u2019s PUFs.[\/vc_column_text][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text]Medicare Part D plans have the flexibility to design drug formularies and structure tiers as long as they meet the formulary design requirements of the Centers for Medicare &amp; Medicaid Services (CMS). Since 2017, plans have had the option to include a greater proportion of generic drugs on the non-preferred tier if they replace the&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"tags":[],"content-categories":[129],"class_list":["post-22091","post","type-post","status-publish","format-standard","hentry","category-insights","content-categories-drug-pricing","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Generic Drug Placement on Part D Generic Tiers Declines Again in 2021 | Avalere Health Advisory<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/advisory.avalerehealth.com\/insights\/generic-drug-placement-on-part-d-generic-tiers\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Generic Drug Placement on Part D Generic Tiers Declines Again in 2021 | Avalere Health Advisory\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column][vc_column_text]Medicare Part D plans have the flexibility to design drug formularies and structure tiers as long as they meet the formulary design requirements of the Centers for Medicare &amp; Medicaid Services (CMS). 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Since 2017, plans have had the option to include a greater proportion of generic drugs on the non-preferred tier if they replace the&hellip;","og_url":"https:\/\/advisory.avalerehealth.com\/insights\/generic-drug-placement-on-part-d-generic-tiers","og_site_name":"Avalere Health Advisory","article_published_time":"2021-03-11T21:26:42+00:00","article_modified_time":"2024-05-08T18:10:50+00:00","author":"avalere_wp","twitter_card":"summary_large_image","twitter_creator":"@avalerehealth","twitter_site":"@avalerehealth","twitter_misc":{"Written by":"avalere_wp","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/advisory.avalerehealth.com\/insights\/generic-drug-placement-on-part-d-generic-tiers#article","isPartOf":{"@id":"https:\/\/advisory.avalerehealth.com\/insights\/generic-drug-placement-on-part-d-generic-tiers"},"author":{"name":"avalere_wp","@id":"https:\/\/advisory.avalerehealth.com\/#\/schema\/person\/6cea6678c016753ac38b9aad6cff71aa"},"headline":"Generic Drug Placement on Part D Generic Tiers Declines Again in 2021","datePublished":"2021-03-11T21:26:42+00:00","dateModified":"2024-05-08T18:10:50+00:00","mainEntityOfPage":{"@id":"https:\/\/advisory.avalerehealth.com\/insights\/generic-drug-placement-on-part-d-generic-tiers"},"wordCount":467,"commentCount":0,"publisher":{"@id":"https:\/\/advisory.avalerehealth.com\/#organization"},"articleSection":["Insights &amp; 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