scholarly journals Financial Burden for Patients With Chronic Myeloid Leukemia Enrolled in Medicare Part D Taking Targeted Oral Anticancer Medications

2017 ◽  
Vol 13 (2) ◽  
pp. e152-e162 ◽  
Author(s):  
Chan Shen ◽  
Bo Zhao ◽  
Lei Liu ◽  
Ya-Chen Tina Shih
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Financial Burden ◽  
Medicare Part D ◽  
Drug Costs ◽  
Medicare Part ◽  
High Price ◽  
Part D ◽  
Coverage Gap ◽  
Donut Hole

Purpose: The number of targeted oral anticancer medications (TOAMs) has grown rapidly in the past decade. The high cost of TOAMs raises concerns about the financial aspect of treatment, especially for patients enrolled in Medicare Part D plans because of the coverage gap. Methods: We identified patients with chronic myeloid leukemia (CML) who were new TOAM users from the SEER registry data linked with Medicare Part D data, from years 2007 to 2012. We followed these patients throughout the calendar year when they started taking the TOAMs and examined their out-of-pocket (OOP) payments and gross drug costs, taking into account their benefit phase, plan type, and cost share group. Results: We found that 726 (81%) of the 898 patients with CML who received TOAMs had reached the catastrophic phase of their Medicare Part D benefit within the year of medication initiation, with a large majority of patients reaching this phase in less than a month. Patients without subsidies showed a clear pattern of a spike in OOP payments when they began treatment with TOAMs. The OOP payment for patients with subsidies was substantially lower. The monthly gross drug costs were similar between patients with and without subsidies. Conclusion: Patients experience quick entry and exit from the coverage gap (also called the donut hole) as a result of the high price of TOAMs. Closing the donut hole will provide financial relief during the initial month(s) of treatment but will not completely eliminate the financial burden.

The Medicare Part D Coverage Gap, Prescription Use, and Expenditures

2018 ◽  
Vol 77 (5) ◽  
pp. 442-450 ◽  
Author(s):  
Aig Unuigbe
Keyword(s):  
Affordable Care Act ◽  
Financial Risk ◽  
Medicare Part D ◽  
Medicare Part ◽  
General Increase ◽  
Part D ◽  
Coverage Gap ◽  
Heterogeneous Effects ◽  
Drug Expenditures ◽  
Donut Hole

The Affordable Care Act has put in place policies to gradually close the Medicare Part D coverage gap (donut hole). I examine the effect of this gradual closure on total and out-of-pocket prescription drug expenditures, as well as the number of prescriptions filled. The analysis shows a general increase in prescription use. There are also heterogeneous effects, with higher total expenditure groups seeing a decrease in their out-of-pocket prescription expenditures. This suggests that closure of the “donut hole” has led to an increase in prescription use that was previously curtailed and had an impact on the financial risk faced by Medicare recipients. This has implications for trends in prescription use and Medicare expenditures in the future, as the coverage gap is closed further.

scholarly journals Does Closing the Donut Hole Reduce Financial Burdens Among Medicare Part D Beneficiaries?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 906-906
Author(s):  
Yalu Zhang ◽  
Lan Liu ◽  
Jingjing Sun ◽  
Xinhui Zhang ◽  
Jiling Sun ◽  
...  
Keyword(s):  
Prescription Drugs ◽  
Medical Expenditure Panel Survey ◽  
Financial Burden ◽  
Medicare Part D ◽  
Medical Expenditure ◽  
Medicare Part ◽  
Absolute Poverty ◽  
Part D ◽  
Donut Hole ◽  
Financial Burdens

Abstract The Medicare Part D donut hole has been gradually closed since 2010. But it is still unclear how it has impacted the beneficiaries’ relative financial burdens, especially in the later stage of the closing plan. The measurement of catastrophic health expenditure induced by prescription drugs (CHE-Rx) reflects the relative financial burdens to beneficiaries’ household income, which bears more information than the measure of dollar-value expenses or the absolute poverty line used in prior studies. Using the Medical Expenditure Panel Survey 2008-2017 longitudinal national representative data and the method of difference-in-differences, this study found that the donut hole closing policy was associated with more usage of prescription drugs (b=2.84, p=0.023) and a higher likelihood of experiencing CHE-Rx (b=2.4%, p=0.011) among those who fell in the donut holes. Besides, the results show that the donut hole closing policy did not generate any immediate effects on prescription drug usage, CHE, and CHE-Rx. For the first time, this paper examined both the aggregated and marginal impact of the policy implementation, which had closed by an additional 35% between 2013 and 2017, on the relative financial burden among the beneficiaries.

scholarly journals Medicare Part D Cost Sharing And Specialty Drug Initiation In Newly Diagnosed Chronic Myeloid Leukemia Patients

2016 ◽  
Vol 19 (3) ◽  
pp. A3
Author(s):  
J.A. Doshi ◽  
P. Li ◽  
H. Huo ◽  
A.R. Pettit ◽  
R. Kumar ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Cost Sharing ◽  
Myeloid Leukemia ◽  
Medicare Part D ◽  
Medicare Part ◽  
Newly Diagnosed ◽  
Part D

scholarly journals Rising Prices of Targeted Oral Anticancer Medications and Associated Financial Burden on Medicare Beneficiaries

2017 ◽  
Vol 35 (22) ◽  
pp. 2482-2489 ◽  
Author(s):  
Ya-Chen Tina Shih ◽  
Ying Xu ◽  
Lei Liu ◽  
Fabrice Smieliauskas
Keyword(s):  
Price Competition ◽  
Financial Burden ◽  
Private Insurance ◽  
Medicare Part D ◽  
Medicare Part ◽  
Study Cohort ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Coverage Gap ◽  
The Impact

Purpose The high cost of oncology drugs threatens the affordability of cancer care. Previous research identified drivers of price growth of targeted oral anticancer medications (TOAMs) in private insurance plans and projected the impact of closing the coverage gap in Medicare Part D in 2020. This study examined trends in TOAM prices and patient out-of-pocket (OOP) payments in Medicare Part D and estimated the actual effects on patient OOP payments of partial filling of the coverage gap by 2012. Methods Using SEER linked to Medicare Part D, 2007 to 2012, we identified patients who take TOAMs via National Drug Codes in Part D claims. We calculated total drug costs (prices) and OOP payments per patient per month and compared their rates of inflation with general health care prices. Results The study cohort included 42,111 patients who received TOAMs between 2007 and 2012. Although the general prescription drug consumer price index grew at 3% per year over 2007 to 2012, mean TOAM prices increased by nearly 12% per year, reaching $7,719 per patient per month in 2012. Prices increased over time for newly and previously launched TOAMs. Mean patient OOP payments dropped by 4% per year over the study period, with a 40% drop among patients with a high financial burden in 2011, when the coverage gap began to close. Conclusion Rising TOAM prices threaten the financial relief patients have begun to experience under closure of the coverage gap in Medicare Part D. Policymakers should explore methods of harnessing the surge of novel TOAMs to increase price competition for Medicare beneficiaries.

Abstract P12: Medication Therapy Management Services - A Requirement for Medicare Part D Plans: Are Your Patients Eligible?

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Sarah A Spinler ◽  
Mark J Cziraky ◽  
Paul S Chan ◽  
Feng-ming Tang ◽  
Gladys G Duenas ◽  
...  
Keyword(s):  
Drug Cost ◽  
Average Cost ◽  
Medicare Part D ◽  
Medication Therapy Management ◽  
Drug Costs ◽  
Medicare Part ◽  
Cardiac Diseases ◽  
Part D ◽  
Therapy Management ◽  
Medication Therapy

Background: Medication Therapy Management (MTM) is a mandated component of Medicare Part D whereby a pharmacist-patient encounter identifies, resolves and prevents medication-related problems. MTM programs have been shown to improve drug therapy goal attainment while reducing overall costs in cardiac patients; however, MTM has been greatly underutilized. The purpose of this study is to identify the proportion of patients eligible for MTM from those enrolled in the NCDR's outpatient PINNACLE Registry. Methods: MTM eligibility is based on the presence of multiple chronic diseases and medications plus the likelihood of exceeding an annual drug cost threshold ($4000 in 2009 and $3000 in 2010). Patients from PINNACLE (5/1/08 to 9/30/10) with 3 or more of the following diseases were identified: HTN, HF, dyslipidemia, DM, CAD. Patient demographics, cardiac diseases, and cardiac drug classes prescribed (individual drugs not available) were captured. To estimate individual patient drug costs to determine MTM eligibility, a weighted average cost was calculated using nationally representative drug utilization data and average wholesale prices (AWP). Sensitivity analyses for determining MTM eligibility were performed by varying drug costs using AWP for the highest cost and clinician-defined most frequently prescribed drugs in each class. Results: Of the 160,593 Medicare patients enrolled in PINNACLE, 93,089 (58%) were identified with ≥ 3 cardiac diseases. The cohort’s mean age was 74.4 ± 9.2 yrs, 54.4% were male and 86.5% were white. Patients were prescribed a mean of 3.5 cardiac drugs. The table displays drug costs and MTM eligibility results. Conclusions: A substantial number of patients met MTM eligibility requirements with this conservative approach using only cardiac drug costs, although variability existed based on cost method. These data serve to raise cardiologists' awareness of their patients' potential eligibility to receive the benefits of MTM services. Cost Methodology Median Annual Cost (IQR) 2009 MTM Eligibility [N (%)] 2010 MTM Eligibility [N (%)] Weighed average cost $1329 (915,2609) 6,202 (6.7% ) 19,903 (21.4%) Frequently prescribed cost $366 (193,1361) 1084 (1.2% ) 7326 (7.9%) High cost $3,958 (2406,5358) 46,477 (49.9% ) 59,619 (64%) 2009 and 2010 MTM eligibility based on likelihood of exceeding drug cost threshold of $4000 and $3000, respectively. IQR - interquartile range; MTM - medication therapy management.

Medicare Part D is Associated With Reducing the Financial Burden of Health Care Services in Medicare Beneficiaries With Diagnosed Diabetes

Medical Care ◽  
2013 ◽  
Vol 51 (10) ◽  
pp. 888-893 ◽  
Author(s):  
Rui Li ◽  
Edward W. Gregg ◽  
Lawrence E. Barker ◽  
Ping Zhang ◽  
Fang Zhang ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Financial Burden ◽  
Medicare Part D ◽  
Medicare Part ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Care Services ◽  
Diagnosed Diabetes
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