JCO oncology practice · 2025
Reducing Medicare Part D Out-of-Pocket Costs for Specialty Oral Anticancer Drugs Under the Inflation Reduction Act: Highlighting the Benefits of Enrolling in the Medicare Prescription Payment Plan.
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Doshi Jalpa A, Li Pengxiang, Asthana Shravan, Lin John K
Аннотация
PURPOSE: Medicare Part D beneficiaries who do not qualify for low-income subsidies face high out-of-pocket (OOP) costs for brand-name specialty oral anticancer medications (SOAMs). We calculated how OOP costs for such SOAMs might evolve on the basis of the Inflation Reduction Act's (IRA) Part D benefit changes.
METHODS: We calculated OOP costs for 10 commonly used brand-name SOAMs across various cancers under four Part D benefit scenarios: (1) 2023: before IRA implementation (pre-IRA), (2) 2024: an annual OOP maximum set at the catastrophic threshold during initial IRA implementation (mid-IRA), (3) 2025: an annual OOP maximum set at $2,000 in US dollars (USD) after final IRA implementation (post-IRA, default), and (4) 2025: $2,000 USD annual OOP maximum and voluntary enrollment in the Medicare Prescription Payment Plan (MPPP) to smooth OOP costs via monthly payments (post-IRA, opt-in MPPP).
RESULTS: In 2023 (pre-IRA), annual OOP costs for SOAMs ranged from $11,143 USD to $20,592 USD. In 2024 (mid-IRA) and 2025 (post-IRA), beneficiaries would only pay the new OOP maximums of $3,333 USD and $2,000 USD, respectively, regardless of SOAM prescribed or treatment duration. In 2025, the $2,000 USD OOP amount would be entirely frontloaded in January unless beneficiaries enroll in the MPPP, which could lower their OOP costs to just $167 USD for January and each calendar month thereafter, regardless of SOAM prescribed or treatment duration.
CONCLUSION: Although the annual OOP maximum enacted by the IRA will decrease OOP costs significantly for Medicare beneficiaries treated with brand-name SOAMs beginning 2025, enrollment in the MPPP is critical to avoid patients owing the entire $2,000 USD in January alone. Oncology providers have a critical role to play in ensuring beneficiaries are aware of the option to smooth their OOP costs via MPPP enrollment.
METHODS: We calculated OOP costs for 10 commonly used brand-name SOAMs across various cancers under four Part D benefit scenarios: (1) 2023: before IRA implementation (pre-IRA), (2) 2024: an annual OOP maximum set at the catastrophic threshold during initial IRA implementation (mid-IRA), (3) 2025: an annual OOP maximum set at $2,000 in US dollars (USD) after final IRA implementation (post-IRA, default), and (4) 2025: $2,000 USD annual OOP maximum and voluntary enrollment in the Medicare Prescription Payment Plan (MPPP) to smooth OOP costs via monthly payments (post-IRA, opt-in MPPP).
RESULTS: In 2023 (pre-IRA), annual OOP costs for SOAMs ranged from $11,143 USD to $20,592 USD. In 2024 (mid-IRA) and 2025 (post-IRA), beneficiaries would only pay the new OOP maximums of $3,333 USD and $2,000 USD, respectively, regardless of SOAM prescribed or treatment duration. In 2025, the $2,000 USD OOP amount would be entirely frontloaded in January unless beneficiaries enroll in the MPPP, which could lower their OOP costs to just $167 USD for January and each calendar month thereafter, regardless of SOAM prescribed or treatment duration.
CONCLUSION: Although the annual OOP maximum enacted by the IRA will decrease OOP costs significantly for Medicare beneficiaries treated with brand-name SOAMs beginning 2025, enrollment in the MPPP is critical to avoid patients owing the entire $2,000 USD in January alone. Oncology providers have a critical role to play in ensuring beneficiaries are aware of the option to smooth their OOP costs via MPPP enrollment.