Medicare Part D Spending on Oral Anti-Cancer Drugs Doubles Interview with:
Emily S. Ruiz, MD, MPH

Director, High-Risk Skin Cancer Clinic, Dana Farber/Brigham and Women’s Cancer Center
Assistant Professor, Harvard Medical School, Dermatology
Brigham And Women’s Faulkner Hospital What is the background for this study?

Response: Innovation in oncology has led to increased development and market entry of anticancer drugs. For example, from 2009 to 2013, the US FDA approved 51 oral and systemic anticancer drugs for 63 indications. Prices for anticancer drugs have risen faster than inflation over time, especially for older drugs, and prices in the US have largely been set by market forces rather than novelty or efficacy.

Understanding the evolving cancer economic landscape requires consideration of annual and cumulative rates of change for key metrics, such as total spending, drug cost per beneficiary, out-of-pocket cost, and utilization. This study sought to weigh the proportional impacts of rising drug costs and utilization on increased Medicare Part D spending for a cohort of oral anticancer drug utilized from 2013-2017. What are the main findings? 

Response: The study found that annualized total spending on 56 drugs prescribed each year from 2013 to 2017 increased by 118% from $5 billion to $10.9 billion. Drug cost per beneficiary treated had a compound annual growth rate of 13% above inflation, rising 66% over the study period. Almost one-quarter of the drugs were more expensive per beneficiary by 2017 than the most expensive drug in 2013. Utilization rose 32% from an average of 11,426 beneficiaries treated per drug in 2013 to 15,051 in 2017. What should readers take away from your report? 

Response: Annualized spending on the same oral anticancer drugs more than doubled in a 5-year period. Increased spending was predominantly driven by rising drug costs (56%), reflective of pharmaceutical pricing strategies, whereas utilization accounted for 44% of the spending increase. High-drug prices upon market entry are often attributed to research and development costs, but R&D may not explain the subsequent increases in drug costs in this study. What recommendations do you have for future research as a result of this work?

Response: Future studies should assess whether costs are offset by savings from decreased inpatient or infusion therapy, the impact of price on utilization, and whether patient demographics correspond with utilization.


Seiger K, Mostaghimi A, Silk AW, Schmults CD, Ruiz ES. Association of Rising Cost and Use of Oral Anticancer Drugs With Medicare Part D Spending From 2013 Through 2017. JAMA Oncol. Published online November 07, 2019. doi: 


Last Modified: [last-modified]


The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


Last Updated on November 9, 2019 by Marie Benz MD FAAD