Even with Smaller Donut Hole, Medicare Cancer Pill Costs Stay High
Researchers compared benefits available in 2010 to the coverage set to take effect in 2020 and estimated changes in out-of-pockets costs under various drug pricing scenarios.
Seniors insured by Medicare may still face high out-of-pocket costs for oral cancer medicines even after the government health program scales back a coverage gap known as the donut hole.
In 2010, the donut hole kicked in once drug spending reached $2,960 and required patients to shoulder 100% of the costs out-of-pocket until their expenses reached $4,700. Beginning in 2020, patients will only need to pay 25% of costs out-of-pocket. Though the donut hole is beneficial for many individuals who obtain prescription drugs through Part D, it doesn't work for people using high-cost drugs like anticancer therapies. To see how changes in coverage might influence out-of-pocket costs, Dusetzina and Nancy Keating of Harvard Medical School and Brigham and Women's Hospital analyzed 2014 Medicare data for stand-alone Part D plans and prescription coverage by private insurers through Medicare Advantage.
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