METHODS: Systematic review of the literature was conducted to identify generic drugs with significant price increases. The coverage trends for the selected drugs for all health plans were obtained from CMS. For each plan the data was obtained for the drug name, tier status, deductibles, and type of restrictions. The coverage trends were analyzed by drug name, state level and at a national level. 

RESULTS: We identified five generic drugs whose price was increased by 500-5000% during the last 24 months. We identified 829 coverage policies for the five generic drugs (doxycycline glycopyrrolate, pravastatin, lisinopril, pyrimethamine). Among these plans, only 30% covered these generic drugs at Tier 1. The other 24%, 19% and 23% of the plans covered the selected generic drugs at Tier 2, 3 and 4, respectively. Only 24% of the plans covered these drugs as a ‘generic’, others covered them as non-preferred brand (24%), preferred brand (18%) and preferred generic (28%). The patient co-pay and co-insurance vary significantly across plans and type of formulation. For example, for Doxycycline oral,  few plans (15%) still have low co-pay of $5-10, while majority have co-insurance ranging from 25-47%. Similarly, injectable formulation of Glycopyrrolate has co-insurance of 33-47% (which can lead to a high patient cost share of $1400 per month). 

CONCLUSIONS: This is a first in-depth analysis of access trends for generics with high price increases. This study shows that patient access for some generic drugs has been restricted significantly.