Your Money or Your Life — under
Medicare Part D
List of authors .
The High Cost of Cancer Drugs
Stacie B . Dusetzina , Ph . D . May 4 , 2022 DOI : 10.1056 / NEJMp2202726 https :// ww ww . nejm . org / doi / full / 10.1056 / NEJMp2202726
The financial burden associated with orally administeredd anticancer drugs can be overwhelming for Medicare beneficiaries . Policies adding an out-of-pocket spending cap to Part D have been proposed
, and Congress could permit price negotiation for anticancer drugs .
Undergoing cancer treatment is physically , emotionally , and financially burdensome . 1 For people whose treatment regimens include orally administered anticancer drugs , the financial burden associated with thesee medications can be overwhelming . About half of anticancer drugs are orally administered . Such drugs provide distinct benefits for patients , since they can reduce the amount of time spent receiving infusions and traveling to appointments .
Orally administered drugs are nearly always offered under a health plan ’ s prescription- benefit . drug benefit , rather than the medical For younger patients with cancer , this distinction may be of limited importance , since both pharmacy and medical spending count toward annual limits on in-network set by the Affordable
Care Act for private plans . For Medicare
, out-of-pocket spending
beneficiaries ( the population most likely to be diagnosed with cancer ), however , there are considerable financial implications associated with medications being covered under Medicare ’ s pharmacy benefit instead of the medical benefit . Most beneficiaries would be responsiblee for high ( and unlimited
) out-of-pocket spending for drugs filled under their pharmacy benefit ( Medicare Part D ). The same beneficiaries typically wouldn ’ t face the prospect of
unlimited spending for drugs that are covered under the medical benefit ( e . g ., physician-administered drugs offered as part of Medicaree Part B ), since 90 % of Medicare beneficiaries have supplemental coverage that reduces or eliminates these out-of-pocket costs .
Spending for Medicare Beneficiaries without Subsidies Filling Prescriptions for Anticancer Medications through
Medicare Part D , 2022 .
One way to illustrate this issue is to consider a Medicare beneficiary who has been newly diagnosed with metastatic breast cancer . For a patientt with hormone receptor – positive , human epidermal growth factor receptor type 2 ( HER2 )– negativee