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Medicare Part D Enrollees with Serious Health Conditions Can Face
Thousands of Dollars in Out-of-Pocket Costs Annually for Specialty Drugs
Despite Medicare’s protections, Part D enrollees
with serious health conditions can face thousands of dollars in annual
out-of-pocket costs for expensive specialty drugs, a new KFF anaylsis finds.
The analysis draws on data from Medicare’s Plan
Finder website to calculate expected annual 2019 costs for more than two
dozen specialty tier drugs used to treat four health conditions -- cancer,
hepatitis C, multiple sclerosis and rheumatoid arthritis – based on coverage
and costs in national and near-national stand-alone drug plans, using a
pharmacy in Baltimore, MD. It found that expected median out-of-pocket costs
for Part D enrollees not receiving low-income subsidies would range from
$2,622 for Zepatier (for hepatitis C) to $16,551 for Idhifa (for leukemia) in
2019.
 The findings come at a time when the public has expressed concern about the rising cost of prescription drugs and policymakers are considering ways to curb such spending, especially in public programs like Medicare and Medicaid.
Medicare beneficiaries continue to confront high
out-of-pocket costs for specialty medications even now that the Part D
coverage gap for brand-name drugs (the so-called “doughnut hole”) has been
closed. Medicare requires Part D enrollees to pay 5 percent coinsurance when
their total annual out-of-pocket spending exceeds an annual threshold ($5,100
in 2019), a benchmark that is commonly surpassed by beneficiaries who take
just one high-priced specialty drug and people who take multiple costly
drugs. The catastrophic threshold is not an absolute limit on out-of-pocket
spending.
For more analysis of Medicare and prescription
drug costs, including our updated 10 Essential Facts about Medicare and Prescription Drug
Spending, visit kff.org.
Filling
the need for trusted information on national health issues, the
Kaiser Family Foundation is a nonprofit organization based in San Francisco,
California.
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Tuesday, January 29, 2019
Medicare Part D Enrollees with Serious Health Conditions Can Face Thousands of Dollars in Out-of-Pocket Costs Annually for Specialty Drugs
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