Table 2.
Common Formulary Structures Used by Stand-Alone Part D and Medicare Advantage Part D Plan/Product Formularies for Orally Administered Cancer Medications in 2014
| Benefit Structure | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| $310 Deductible, 25% Coinsurance Initial, 45% Coinsurance Gap, 5% Coinsurance Catastrophic (%) | $0 Deductible, 33% Coinsurance Initial, 45% Coinsurance Gap, 5% Coinsurance Catastrophic (%) | $0 Deductible, 33% Coinsurance Initial, 33% Coinsurance Gap, 5% Coinsurance Catastrophic (%) | $0 Deductible, 25% Coinsurance Initial, 45% Coinsurance Gap, 5% Coinsurance Catastrophic (%) | Cumulative Coverage of Selected Designs (%) | ||||||
| Drug | PDP | MA-PD | PDP | MA-PD | PDP | MA-PD | PDP | MA-PD | PDP | MA-PD |
| Abiraterone | 45.6 | 12.6 | 43.4 | 48.3 | 3.3 | 15.1 | 0.4 | 5.3 | 92.7 | 81.3 |
| Afatinib | 45.7 | 13.0 | 43.3 | 45.5 | 3.3 | 17.6 | 1.2 | 6.5 | 93.5 | 82.6 |
| Axitinib | 45.7 | 12.7 | 43.2 | 45.9 | 3.3 | 16.3 | 1.0 | 7.0 | 93.2 | 81.9 |
| Cabozantinib | 45.7 | 13.0 | 43.3 | 45.4 | 3.3 | 17.6 | 1.2 | 6.6 | 93.5 | 82.6 |
| Crizotinib | 45.7 | 12.8 | 43.2 | 47.1 | 3.3 | 16.3 | 1.0 | 5.8 | 93.2 | 82.0 |
| Dabrafenib | 45.7 | 12.8 | 43.2 | 47.1 | 3.3 | 16.3 | 1.0 | 5.8 | 93.2 | 82.0 |
| Dasatinib | 45.3 | 12.5 | 44.8 | 44.2 | 3.2 | 21.8 | 0.4 | 6.0 | 93.7 | 84.5 |
| Enzalutamide | 45.6 | 12.5 | 43.4 | 48.6 | 3.3 | 15.1 | 0.4 | 4.8 | 92.7 | 81.0 |
| Erlotinib | 45.7 | 13.1 | 43.3 | 45.3 | 3.3 | 17.6 | 1.2 | 6.8 | 93.5 | 82.8 |
| Everolimus | 45.3 | 12.5 | 45.0 | 42.6 | 3.0 | 22.1 | 0.7 | 6.6 | 94.0 | 83.8 |
| Imatinib | 45.7 | 12.8 | 43.2 | 45.9 | 3.3 | 16.3 | 1.0 | 7.2 | 93.2 | 82.2 |
| Lapatinib | 45.7 | 12.6 | 43.4 | 48.4 | 3.3 | 15.1 | 0.5 | 5.3 | 92.9 | 81.4 |
| Lenalidomide | 45.3 | 12.7 | 44.8 | 44.3 | 3.2 | 21.9 | 0.4 | 5.7 | 93.7 | 84.6 |
| Nilotinib | 45.7 | 12.8 | 43.2 | 47.0 | 3.3 | 16.3 | 1.0 | 6.0 | 93.2 | 82.1 |
| Pazopanib | 45.6 | 12.6 | 43.4 | 47.6 | 3.3 | 15.1 | 0.4 | 5.9 | 92.7 | 81.2 |
| Pomalidomide | 45.4 | 12.8 | 44.0 | 45.3 | 3.3 | 19.2 | 0.7 | 6.5 | 93.4 | 83.8 |
| Regorafenib | 45.6 | 12.5 | 43.3 | 48.5 | 3.3 | 15.1 | 0.4 | 4.9 | 92.6 | 81.0 |
| Sorafenib | 45.6 | 12.6 | 43.4 | 47.6 | 3.3 | 15.1 | 0.8 | 5.8 | 93.1 | 81.1 |
| Sunitinib | 45.7 | 13.1 | 43.3 | 44.5 | 3.3 | 17.6 | 1.2 | 7.4 | 93.5 | 82.6 |
| Trametinib | 45.7 | 12.7 | 43.2 | 46.9 | 3.3 | 16.3 | 1.0 | 6.0 | 93.2 | 81.9 |
| Vandetanib | 45.7 | 13.0 | 43.2 | 47.8 | 3.3 | 16.7 | 1.0 | 4.2 | 93.2 | 81.7 |
| Vemurafenib | 45.6 | 12.6 | 43.4 | 48.4 | 3.3 | 15.1 | 0.4 | 5.0 | 92.7 | 81.1 |
| Vorinostat | 45.6 | 12.5 | 43.4 | 48.2 | 3.3 | 15.1 | 0.4 | 5.3 | 92.7 | 81.1 |
NOTE. Proportions reflect the percentage of plan/products that cover the relevant drug that uses the listed formulary structure. Analysis is based on the July 15, 2014, quarterly release of the Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from the Centers for Medicare & Medicaid Services. Abbreviations: MA-PD, Medicare Advantage Part D Plan/Product formulary; PDP, Part D Plan/Product formulary.