Two major Medicare Part D drug plans recently stopped requiring prior authorization for coverage of Alzheimer's medications, according to officials at the Alzheimer's Association.
RxAmerica and Medco no longer will require physicians to go through the prior authorization process before they prescribe Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine) for Medicare Part D beneficiaries over age 65.
With these announcements, SilverScript, a subsidiary of Caremark, becomes the only national or near-national Part D drug plan sponsor that still requires prior authorization, according to the Alzheimer's Association.
The nine other national or near-national plans do not require prior authorization. Caremark spokesman Dale Thomas said the company is in contact with officials at the Centers for Medicare and Medicaid Services and the Alzheimer's Association but had no further comment at press time.
This summer, officials with the Alzheimer's Association wrote to CMS citing problems that beneficiaries had experienced in getting access to Alzheimer's drugs after the end of the initial Medicare Part D transition period on March 31. The group also noted in its letter that it was “unrealistic and unreasonable” for prior authorization denials to be addressed through the appeals process.
“Neither frail patients nor their physicians can be expected to navigate the plan system and file additional documentation in order to obtain these medications that are on the plan's formulary,” Stephen McConnell, vice president of advocacy and public policy at the Alzheimer's Association said in the letter. “The unfortunate consequence will be that patients will not receive the medications from which they will benefit.”
Officials at the Alzheimer's Association sent copies of the letter to the three Part D drug plans and received quick responses from RxAmerica and Medco about plans to change their policies, according to Leslie B. Fried, director of the Medicare Advocacy Project of the Alzheimer's Association. While officials at Caremark have yet to make a change in their policy, Ms. Fried said they are in contact with the company and are hopeful they will reverse the policy. “Now they are really an outlier,” she said.
Removing prior authorization is vital, according to Dr. Marc Nuwer, professor of neurology at the University of California in Los Angeles. For every prior authorization request, the physician has to go back over the patient records looking for dates and other treatment information. “It's a hassle,” he said.
The change being made by some companies is recognition not only that removing prior authorization requirements is good medicine and good public relations, but also that it's good business for the plans, Dr. Nuwer said.