Impact of increasing the Medicare Part D specialty threshold

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By Bruce S. Pyenson, Gabriela Dieguez, Jennifer Carioto | 16 October 2015

Most Medicare Part D plans offer “tiered” benefits that establish varying levels of cost sharing for different types of drugs, including a specialty tier for high-cost Part D drugs. The threshold for inclusion of a drug in the specialty tier is currently $600. In this report, Milliman modeled the impact of increasing the threshold to $700, $750, and $800 on patient spending, Part D premiums, Part D plans, the federal reinsurance program, and drug manufacturers using historical Part D data and sample Part D benefits and formularies.

This report was commissioned by Avanir.