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. 2017 Aug 1;35(22):2482-2489.
doi: 10.1200/JCO.2017.72.3742. Epub 2017 May 4.

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

Ya-Chen Tina Shih  1 , Ying Xu  1 , Lei Liu  1 , Fabrice Smieliauskas  1
Affiliations

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

Ya-Chen Tina Shih et al. J Clin Oncol. .

Abstract

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.

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Figures

Fig 1.
Fig 1.
Annual targeted oral anticancer medication costs of Medicare Part D beneficiaries, 2007 to 2012. (A) Mean costs per patient per month (PPPM); (B) median costs PPPM; (C) costs PPPM at 75th percentile; (D) costs PPPM at 95th percentile. LIS, low-income subsidy; OOP, out-of-pocket.
Fig 2.
Fig 2.
Launch prices and 2012 prices of targeted oral anticancer medication in Medicare Part D by year of launch, 2007 to 2012. (A) Launch year or 2007 (whichever was later); (B) 2012 prices.
Fig 3.
Fig 3.
Rate of annual price change, 2007 to 2015. Dashed gray line represents projection on the basis of data published by Centers for Medicare & Medicaid Services. CPI, Consumer Price Index; MC, medical care; OOP, out-of-pocket; PPPM, per patient per month; RX, prescription drug; TOAM, targeted oral anticancer medication.
Fig 4.
Fig 4.
Inflation rates for various medical goods, 2007 to 2012. CPI, Consumer Price Index; OOP, out-of-pocket; RX, prescription drug; TOAM, targeted oral anticancer medication.
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