- The expected average out-of-pocket spend for seniors who take specialty cancer drugs orally this year is $10,470, up from $8,794 in 2010, according to a recent JAMA report that analyzes Medicare Part D point of sale spending data from 2010 to 2018.
- The estimated of out-of-pocket spending on specialty cancer drugs in 2019 is expected to range from $7,220 to as high as $15,472 for the multiple myeloma drug lenalidomide.
- The number of cancer drugs covered has increased from 13 in 2010 to 54 in 2018, at the same time the average monthly point of sale price has increased from about $7,000 to nearly $14,000, according to the report.
High drug prices and the insurance benefit design within Medicare Part D leaves seniors exposed to significant costs when purchasing specialty cancer medications, according to the study.
The Trump administration has made lowering drug prices a priority, releasing a blueprint last year on how to achieve that goal. Last week, CMS released its final rule on tackling drug prices in the Medicare Part D program but rolled back some previous proposals, including one that would have allowed plans to deny coverage for certain protected drug classes, including cancer drugs.
Medicare Part D coverage does not have a cap on out-of-pocket spending for seniors. Instead, beneficiaries pay a coinsurance, or a percentage of the drug's cost, which could lead to significant costs as drug prices continue to climb, the researchers report.
The study authors call for efforts to reduce drug prices and limits to out-of-pocket spending for seniors.
"Because beneficiaries pay a percentage of the drug's price and have no out-of-pocket spending limits on Part D, even large price decreases may not provide sufficient financial relief to patients requiring long-term anticancer drug use," they write.
The Affordable Care Act did take on out-of-pocket spending issues by reducing the coinsurance for branded drugs in the coverage gap. In 2010, seniors were responsible for 100% of the cost of the drug when they reached the coverage gap. Now, they are responsible for no more than 25%.
The study notes that because it analyzed point of sale prices it does not factor in rebates or discounts. However, it's important to use point of sale figures, according to the authors, because coinsurance is based on the point of sale price.