Specialty Drug Pricing and Out-of-Pocket Costs Continue to Rise Under Part D

Medicare Part D coverage, according to recently published research, leaves older adults at risk of paying higher out-of-pocket costs when purchasing specialty cancer medications. 

A research letter authored by Stacie B Dusetzina, PhD, of the department of health policy at Vanderbilt University School of Medicine, Haiden A Huskamp, PhD, and Nancy L Keating, MD, MPH, both from the department of health care policy at Harvard Medical School, stated that while Part D provides access to prescribed drugs, access to specialty drugs is limited. 

“The number of orally administered anticancer medications covered under Part D has increased since 2010, with mean monthly point-of-sale prices for anticancer drugs reaching nearly $14 000 in 2018,” stated Dr Duesetzina. “Anticancer drug prices have increased beyond inflation between 2010 and 2018, resulting in higher out-of-pocket spending for patients despite the Part D coverage gap closing.” 

Per the research, 13 anticancer drugs were covered by Part D in 2010 vs 54 in 2018. Average price per fill rose over significantly from $7438 to $13992 respectively. 

“Across all drugs and varying years of approval (pre-2010 through 2018), mean prices rose by 5.8% per year above inflation,” found Dr Dusetzina and colleagues. “Changes in mean per-fill price from the first observed fill year to 2018 was 40.4% overall, ranging from a reduction of 44% for generic imatinib ($8570 in 2016 vs $4822 in 2018) to an increase of 306% for gefitinib ($1960 in 2010 vs $7960 in 2018).” 

This research comes after the administration has made lowering drug prices a priority, with the Centers for Medicare & Medicaid Services most recently finalizing a rule focused on prices in the Part D program. However, the most recent rule has rolled back previous proposals, threatening coverage for some specialty medications, including cancer care. 

Dr Dusetzina and colleagues call for efforts to reduce drug prices and work on limiting out-out-of pocket spending for seniors. —Edan Stanley