New research has found that the steady increase in the price of targeted oral anticancer medications (TOAM) is washing out the potential for savings that patients would experience in their out-of-pocket (OOP) payments following closure of the Medicare Part D coverage gap. TOAM OOP costs are relatively moderate for privately-insured patients, but impose a much greater financial burden on Part D beneficiaries. As the coverage gap gradually closes under ACA provisions, the study finds that Part D beneficiaries’ OOP costs for TOAMs has fallen by about 20 percent. However, the inflation in monthly regimen prices for TOAMs was found to be three times that of the medical care component of the consumer price index. The authors of the study fear that the continued inflation in TOAM prices could negate any savings that beneficiaries will experience from the coverage gap closure.
Recommendations include allowing Part D plans to have two specialty tiers, as opposed to the current one specialty tier policy, with patient cost sharing capped on the preferred specialty tier. They also note that the current specialty tier should be reserved for competitor drugs with high prices.