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Out-of-pocket costs of oral anticancer drugs for Medicare beneficiaries vary by strength and formulation

Published:October 10, 2022DOI:https://doi.org/10.1016/j.jgo.2022.10.001
      Medicare beneficiaries filling oral anticancer drug prescriptions often have expected annual out-of-pocket costs exceeding $10,000 [
      • Dusetzina S.B.
      • Huskamp H.A.
      • Keating N.L.
      Specialty drug pricing and out-of-pocket spending on orally administered anticancer drugs in medicare part D, 2010 to 2019.
      ]. Cost-related prescription non-initiation affects almost 1 in 3 Medicare beneficiaries (without low-income subsidies) prescribed high-cost specialty anticancer drugs [
      • Dusetzina S.B.
      • Huskamp H.A.
      • Rothman R.L.
      • et al.
      Many medicare beneficiaries do not fill high-price specialty drug prescriptions.
      ]. While longer-term policy solutions are implemented, there is an urgent need to explore “on-the-ground” affordability solutions. It is unknown how altering medication prescribing could reduce out-of-pocket costs.

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      References

        • Dusetzina S.B.
        • Huskamp H.A.
        • Keating N.L.
        Specialty drug pricing and out-of-pocket spending on orally administered anticancer drugs in medicare part D, 2010 to 2019.
        JAMA. 2019; 321: 2025-2027
        • Dusetzina S.B.
        • Huskamp H.A.
        • Rothman R.L.
        • et al.
        Many medicare beneficiaries do not fill high-price specialty drug prescriptions.
        Health Aff (Millwood). 2022; 41: 487-496
        • Jiang Y.
        • Mason M.
        • Cho Y.
        • et al.
        Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes.
        BMC Cancer. 2022; 22: 950
      1. Centers for Medicare and Medicaid Services. Medicare Provider Utilization and Payment Data: Part D Prescriber. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Part-D-Prescriber. Accessed June 15, 2022.

      2. Medicare.gov. Explore your Medicare coverage options. Available at: https://www.medicare.gov/plan-compare/#/?year=2022&lang=en. Accessed Sep 27, 2022.

      3. U.S. Census Bureau, Population Estimates; Current Population Survey, Annual Social and Economic Supplement; American Community Survey. Available at www.acl.gov. Accessed June 1st, 2022.

        • Gupta R.
        • Morten C.
        • Zhu A.
        • et al.
        Approvals and timing of new formulations of novel drugs approved by the US food and drug administration between 1995 and 2010 and followed through 2021.
        JAMA Health Forum. 2022 May; 3 (PMCID: PMC9123500)
        • Jones G.H.
        • Carrier M.A.
        • Silver R.T.
        • Kantarjian H.
        Strategies that delay or prevent the timely availability of affordable generic drugs in the United States.
        Blood. 2016; 127: 1398-1402
        • Egilman A.C.
        • Zhang A.D.
        • Wallach J.D.
        • Ross J.S.
        Medicare part D spending on single-enantiomer drugs versus their racemic precursors.
        Ann Intern Med. 2019; 171: 521-523
        • Sumarsono A.
        • Sumarsono N.
        • Das S.R.
        • Vaduganathan M.
        • Agrawal D.
        • Pandey A.
        Economic burden associated with extended-release vs immediate-release drug formulations among medicare part D and medicaid beneficiaries.
        JAMA Netw Open. 2020; 3e200181
        • Gupta A.
        • Nshuti L.
        • Grewal U.S.
        • et al.
        Financial burden of drugs prescribed for cancer-associated symptoms.
        JCO Oncol Pract. 2022; 18: 140-147
        • Haque W.
        • Sedhom R.
        • Chino F.
        • Royce T.J.
        • Gupta A.
        Payer-imposed quantity limits for antiemetics: everybody hurts.
        JCO Oncol Pract. 2022; 18: 313-317
        • Hussaini S.M.Q.
        • Sedhom R.
        • Dusetzina S.B.
        • Gupta A.
        Intermediate strengths and inflated prices: the story of transdermal fentanyl patches.
        J Palliat Med. 2022; https://doi.org/10.1089/jpm.2022.0241
        • Aviki E.
        • Moss H.
        • Albright B.
        • et al.
        Overspending driven by dose-specific packaging of lenvatinib for endometrial cancer.
        in: Presented at SGO 2022; March 18–21. 2022 (Abstract 18)
        • Desai N.
        • Besaw R.J.
        • Sedhom R.
        • et al.
        Estimated out-of-pocket costs for cancer-directed and supportive care medications for older adults with advanced pancreatic cancer.
        J Geriatr Oncol. 2022; https://doi.org/10.1016/j.jgo.2022.02.003