High Out-of-Pocket Costs Expected for Medicare Patients Taking Specialty Drugs in 2019

Despite efforts to ease cost burden for Medicare Part D beneficiaries, high out-of-pocket costs for specialty tier drugs continue to be a concern for patients without low-income subsidies.

A new Kaiser Family Foundation (KFF) analysis points to the high out-of-pocket cost burden for Medicare enrollees taking specialty medications, with some expected to spend thousands of dollars out of pocket for a single specialty tier drug in 2019. For the majority of these medications, costs will occur above the catastrophic threshold, translating to $5444 in out-of-pocket costs in the catastrophic phase alone.

Specialty drugs drive a large portion of prescription drug costs in the United States, approaching nearly half of overall medicine spending. In Medicare Part D, spending on these drugs has steadily increased, now comprising more than 20% of total Part D spending despite only being prescribed to a relatively small share of enrollees, according to KFF.

For the analysis, investigators pulled data from Medicare’s Plan Finder website to calculate the expected annual 2019 out-of-pocket costs for 30 specialty tier drugs across 4 conditions: hepatitis C virus (HCV), multiple sclerosis (MS), cancer, and rheumatoid arthritis (RA). Two of the 30 specialty drugs in the analysis, Gleevac and Viekira Pak, are not covered by any plan in 2019.

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