[Reposted: Jalpa A. Doshi, Amy R. Pettit, and Pengxiang Li. Addressing Out-Of-Pocket Specialty Drug Costs In Medicare Part D: The Good, The Bad, The Ugly, And The Ignored, Health Affairs Blog, July 25, 2018. https://www.healthaffairs.org/do/10.1377/hblog20180724.734269/full/: Copyright ©2018 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]
The cost of prescription drugs in the United States has been a popular topic of debate in recent years, particularly when it comes to specialty drugs with very high price tags. High-profile proposals and reports have made a variety of recommendations, leading to a flurry of reactions from all segments of the health care industry. But how would these recommendations directly or indirectly affect out-of-pocket costs for elderly and disabled individuals who are actually taking the most expensive medications? The combination of high drug prices and cost-sharing requirements under Medicare Part D’s current benefit structure results in a high out-of-pocket burden for patients needing specialty drugs. Our research offers insights into how key recommendations would alleviate some burdens, intensify others, and fail to address additional concerns. In particular, many proposals to date have omitted a critical issue: It’s not just how much Medicare Part D patients are asked to pay out of pocket in a given year, but when they are required to pay it.