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Research Letter
May 28, 2019

Specialty Drug Pricing and Out-of-Pocket Spending on Orally Administered Anticancer Drugs in Medicare Part D, 2010 to 2019

Author Affiliations
  • 1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 2Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
JAMA. 2019;321(20):2025-2027. doi:10.1001/jama.2019.4492

For Medicare beneficiaries, Part D provides access to prescribed drugs. However, access to high-priced specialty medications covered by Part D may be limited by increasing drug prices and Part D benefit designs requiring patients to pay a percentage of the drug’s price with every fill through coinsurance. To improve affordability of drugs for patients, the Affordable Care Act has gradually reduced the required coinsurance for branded drugs in the coverage gap (ie, doughnut hole) from 100% in 2010 to 25% in 2019.1 However, price increases over that same period might have offset expected savings for patients needing specialty drugs, including anticancer drugs.2-5 We assessed point-of-sale prices from 2010 to 2018 for orally administered anticancer drugs offered through Medicare Part D and estimated how out-of-pocket spending changed from 2010 to 2019 benefit designs as a result of decreasing coinsurance as the Part D coverage gap closed.

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