Medicare Part D, an optional component of Medicare, helps beneficiaries pay for generic and name-brand prescription drugs. A Low Income Subsidy (LIS) can provide financial support to enrollees with incomes less than 150% of the Federal Poverty Line. However, the out-of-pocket (OOP) costs, which are the expenses that beneficiaries must pay themselves, for those who do not qualify for LIS can remain high, especially for brand-name specialty oral anticancer medications (SOAMs).
A report published in JCO Oncology Practice establishes the financial burden expected given changes to Part D benefits proposed in the Inflation Reduction Act (IRA). The researchers calculated the OOP costs for 10 SOAMs used to treat various cancers under current and proposed Part D scenarios.
The first scenarios considered correspond to 2023 standards, including the benefits occurring before the implementation of the IRA (pre-IRA). Next, the researchers considered when the federal government implemented the IRA in 2024. At this time, OOP costs were limited at a catastrophic level (mid-IRA). The next scenario encompassed time in 2025, after the full implementation of the IRA when OOP costs were capped at $2,000 (post-IRA). Finally, the study evaluated the impact of voluntarily enrolling in the Medicare Prescription Payment Plan (MPPP), which implements monthly payment plans to cover OOP costs (post-IRA, opt-in MPPP).
The study revealed a significant relief from financial burden. With pre-IRA, annual OOP for SOAMs ranged from $11,143 to $20,592. OOP costs were significantly reduced until the mid-IRA (maximum $3,333) and the post-IRA ($2,000) scenarios. For enrollees who opted into MPPP, the $2,000 capped cost would be spread across the year, rendering monthly OOP costs $167.
The study demonstrated that annual OOP maximums, as dictated by the IRA, will significantly decrease OOP costs for Medicare participants requiring SOAMs. These expected cost savings should begin this year, providing substantial savings for SOAMs. The authors stress the crucial role of healthcare providers in informing patients about MPPP enrollment options, empowering beneficiaries to rely on their regular income to pay for anticancer treatments.
Sources: JCO Oncol Prac