Access barriers and cost of varenicline for smoking cessation: A national comparative analysis of Medicare standalone part D and Medicare Advantage plan.

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11080 Background: Smoking cessation is a critical part of cancer prevention and control. Oral varenicline is the most cost-effective medication for smoking cessation, yet seniors enrolled in Medicare Part D Prescription Drug Plans (PDPs) can potentially face costs and access barriers to varenicline in the forms of prior authorization and quantity limits. Although over half of Medicare beneficiaries are now insured and receiving drug benefits through Medicare Advantage, it remains unclear how costs and access barriers compare between PDPs and MA drug plans (MADPs). This study compared plan-level costs and prevalence of prior authorization and quantity limit policies between PDPs and MADPs for oral varenicline. Methods: We used 2023 Q3 MA and PDP data from the Center for Medicare and Medicaid Services, excluding employer-sponsored and Supplemental Need Plans (including dual-eligible plans) and plans with <10 enrollees. We focused on two generic varenicline forms: 0.5mg and 1mg tablets. To compare medication quantities, we calculated the plan-level median (IQR) cost for 30-day supply, based on the average unit cost. Price benchmarks were defined based on average wholesale acquisition cost (WAC) from Micromedex Red Book. T-test and Chi-squared tests were used to compare costs and prevalence of prior authorization and quantity limits. Results: Across 3512 MADPs and 813 PDPs, median costs for a 30-day supply of varenicline were similar (0.5mg tab: $375.32 vs. $376.87, p=0.64; 1mg: $371.88 vs. $376.87, p=0.49, respectively). Median costs for both PDPs and MAPDs were higher than benchmarks; p<0.01 for all). For both varenicline dosages, MAPDs had higher rates of prior authorization (27.1% vs 16.2%, p<0.01) and quantity limits (48.0% vs 30.4%, p<0.01) than PDPs. Conclusions: Varenicline prices in both PDPs and MAPDs were much higher than benchmarks. Compared to PDPs, MAPDs used more prior authorization and quantity limit to control cost. This can create access barriers to this cost-effective medication, burdening patients, physicians, health systems, and pharmacies. [Table: see text]