drug ’ s value . As a result , beneficiaries might be expected to pay roughly the same amount out of pocket for a drug that is associated with substantial survival benefits as for one that does little to improve their quality of life or prognosis .
Policies that would modernize Medicare Part D by adding an annual out-of-pocket spending cap have been proposed in multiple bills , including the currently stalled Build Back Better Act ( BBBA ). Under the BBBA , out-of-pocket Part D spending would be limited to $ 2,000 per year , with an option for beneficiaries to “ smooth ” costs over the calendar year , which would protect many people from facing a very high first-fill cost . A cap on Part D spending would increase access to anticancer drugs and reduce disparities in coverage between orally administered and physician-administered drugs for Medicare beneficiaries with cancer . Both of these outcomes would be important . However , an out-of-pocket cap could result in increased prices for drugs for which coverage is mandated under Part D ( cancer drugs are a protected class and must be covered by all Part D plans ) or a lack of incentives for beneficiaries to choose lower-priced drugs over higher-priced options when spending on both would exceed the cap , since beneficiaries would no longer be responsible for paying high prices .
In addition to capping annual out-of-pocket costs , Congress could allow Medicare to negotiate prices for anticancer drugs to help manage spending in Part D . Because of coverage mandates and the limited number of treatment options , anticancer drugs are subject to minimal price competition . Ideally , negotiated prices would reflect the value that products provide to patients , and cost sharing under Part D would be revised to reduce or eliminate out-of-pocket costs for high-value drugs . The Center for Medicare and Medicaid Innovation could also test alternative cost-sharing designs involving a capped Part D benefit . Such a test could include a monthly cap ( e . g ., $ 250 out of pocket ) or value-based cost sharing to encourage beneficiaries to use higher-value drugs over lower-value ones when multiple treatment options exist .
In February 2022 , President Joe Biden announced a “ reigniting ” of his Cancer Moonshot program , with a goal of reducing the death rate from cancer in the United States by at least 50 % over the next 25 years and “ improving the experience of people and their families living with and surviving cancer .” 5 Ensuring access to prescription drugs with proven benefits and limiting the amount that patients pay out of pocket would be an important first step . Without access , even cures are ineffective .
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