Medicare Advantage, Part D Plans Limit Ondansetron Access

TOPLINE:

Among patients with cancer, Medicare Advantage and Medicare Part D prescription drug plans frequently used prior authorization for ondansetron and often imposed quantity limits on the low-cost antiemetic. Despite ondansetron being more affordable in Medicare Advantage plans, both plan types charge significantly higher prices than the Cost Plus Drug Company.

METHODOLOGY:

• Nearly 80% Medicare beneficiaries in the United States receive prescription drug benefits via Medicare Part D or Medicare Advantage, and these plans may use management tools that hinder patients’ access to ondansetron, despite being available as a low-cost generic since 2006.
• This cross-sectional study, which explored the use of management tools and costs for oral ondansetron across both plan types, included data from the 2023 quarter 3 Centers for Medicare & Medicaid Services database and examined 813 Part D and 3512 Medicare Advantage prescription drug plans.
• Researchers analyzed prior authorization requirements, quantity limits, and plan-level costs for a 30-day supply (90 units) for 4-mg, 8-mg, and orally disintegrating tablets.
• Researchers also compared prices against those from the Mark Cuban Cost Plus Drug Company, a direct-to-consumer pharmacy with fixed markup pricing.

TAKEAWAY:

• Medicare Advantage prescription drug plans used prior authorization (90.3% vs 71.9%) and quantity limits (22.5% vs 16.5%) significantly more often than Part D prescription drug plans (both P
• Compared with Part D plans, Medicare Advantage plans offered significantly lower total costs for both 4-mg ondansetron tablets ($24.40 vs $31.40) and 8-mg ondansetron tablets ($31.5 vs $35.7) but similar costs for orally disintegrating tablets.
• However, both Medicare plans charged significantly more than the Mark Cuban Cost Plus Drug Company prices for all formulations ($9.5 for 4-mg tablets and $14.9 for 8-mg tablets, for instance).

IN PRACTICE:

Despite ondansetron’s decreasing costs, most Medicare Advantage and Part D prescription drug plans “continue to enforce substantial utilization management, limiting patients’ timely access while increasing clinicians’ administrative burdens,” the authors wrote. “Policymakers must prioritize access to high-value medications to prevent unnecessary delays and cost in care.”

SOURCE:

This study, led by Changchuan Jiang, MD, MPH, University of Texas Southwestern Medical Center, Dallas, was published online in JAMA Network Open.

LIMITATIONS:

The use of plan-level data limited analysis of individual patient outcomes, preventing insights into the real-world effects of these policies.

DISCLOSURES:

Two authors were supported by grants from the University of Texas Southwestern Medical Center and the National Cancer Institute. Several authors reported receiving grants and personal fees and having other ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.