Even After ‘Doughnut Hole’ Closes, Cancer Drugs May Still Be Expensive For Medicare Patients

Dr. Stacie B. Dusetzina, PhD Assistant professor in the Division of Pharmaceutical Outcomes and Policy Eshelman School of Pharmacy University of North Carolina

Dr. Dusetzina

MedicalResearch.com Interview with:
Dr. Stacie B. Dusetzina, PhD
Assistant professor in the Division of Pharmaceutical Outcomes and Policy
Eshelman School of Pharmacy
University of North Carolina 

Medical Research: What is the background for this study? What are the main findings?

Dr. Dusetzina: As part of the Affordable Care Act the Medicare Part D “doughnut hole” is closing – reducing Medicare beneficiaries out-of-pocket expenses during this phase of coverage from 100% of drug costs to 25% between 2010 and 2020.  In this study we analyzed 3,344 Medicare formularies that spell out how insurers cover prescription drugs. We found that in 2010, a typical course of oral chemotherapy drugs costs patients on average up to $8,100 per year. When the doughnut hole closes in 2020, patients will still have to pay on average $5,600 out of pocket per year, more than what the average Medicare beneficiary’s household spends on food each year. Even after the doughnut hold is closed oral chemotherapy drugs will still be out of reach for millions of Americans.

Medical Research: What should clinicians and patients take away from your report?

Dr. Dusetzina: High out-of-pocket costs may impact patients’ ability to take their medications as prescribed. It is important for patients and clinicians to discuss financial barriers to taking medications. Policy makers should consider alternative cost-sharing strategies for high-cost / specialty drugs for Medicare beneficiaries. Most of the orally-administered anti-cancer medications are priced at $10,000 per month which is very expensive for patients even during the catastrophic phase of coverage (where patients pay 5% of drug costs).

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Dusetzina: More research is needed regarding strategies that patients are using to manage medication costs and the extent to which these out-of-pocket costs are creating financial hardship / barriers to treatment.

Citation:

Stacie B. Dusetzina and Nancy L. Keating. Mind the Gap: Why Closing the Doughnut Hole Is Insufficient for Increasing Medicare Beneficiary Access to Oral Chemotherapy. Journal of Clinical Oncology, December 2015 DOI: 1200/JCO.2015.63.7736

Dr. Stacie B. Dusetzina, PhD (2015). Even After ‘Doughnut Hole’ Closes, Cancer Drugs May Still Be Expensive For Medicare Patients 

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