Medicare Patients May See Lower Cancer Drug Costs This Spring

Patients with cancer who are insured by Medicare may see lower drug prices over the next few months.

Drug companies must now pay rebates to Medicare when the cost of certain prescriptions increase faster than the rate of inflation. Additionally, there is now lower cost sharing for patients enrolled on Medicare Part B thanks to a provision of the Inflation Reduction Act, which went into effect at the start of the year.

The new pricing standard went into effect on April 1. Now, the beneficiary co-insurance — meaning the out-of-pocket expense for patients on Medicare — will be 20% of the inflation-adjusted payment amount, helping to save money for enrolled patients, according to a press release from the American Society of Clinical Oncology.

READ MORE: Facing Financial Toxicity in Cancer Care

“The Inflation Reduction Act will cap the amount of money seniors pay on prescription drugs at $2,000 a year for cancer and any other diseases. That’s a godsend for so many families.” Presiden Joe Biden said.

In August 2022, shortly before the Inflation Reduction Act was passed, President Joe Biden tweeted, “The Inflation Reduction Act will cap the amount of money seniors pay on prescription drugs at $2,000 a year for cancer and any other diseases. That’s a godsend for so many families.”

Of note, the $2,000 yearly cap on out-of-pocket expenses is expected to take effect in 2025.

The Centers for Medicare & Medicaid Services (CMS) defined rebatable drugs as “a single source drug or biological product, including certain biosimilar biological products, which are generally injectable and infused drugs or biologicals administered by a physician in a doctor’s office or hospital outpatient setting.”

However, not everyone is applauding the act. Republican representative Dr. Brad Wenstrup, member of the Ways and Means committee and co-chair of the GOP Doctors Caucus, stated that the Inflation Reduction Act would drastically decrease the amount of money that pharmaceutical companies can use for the research and development of life-saving drugs.

“The Inflation Reduction Act will wipeout nearly a third of the current annual spending on cancer research and development, leading to fewer new cures and discouraging innovation and investment in an industry that relies heavily on private sector funding,” Wenstrup wrote in an op-ed for United States domestic policy analysis site RealClearPolicy co-authored by representatives Dr. Andy Harris and Dr. Michael Burgess.

The drugs that are included in the new pricing structure may change quarterly, and now the coinsurance adjustments will be visible on the Medicare Part B Quarterly Sales Pricing, a public document found on the CMS website that outlines drug pricing.

Cancer drugs and those used in the oncology setting that are included in the rebate program that patients on Medicare can expect lower payments for include:

• Akynzeo (netupitant and palonosetron), which is used to treat chemotherapy-induced nausea and vomiting
• Atgam, which is used for graft-versus-host disease in patients undergoing stem cell transplant
• Aveed (testosterone undecanoate), an injection that can be used in treatment of certain types of breast cancer
• Cytogam, which is administered after organ transplant to prevent or reduce cytomegalovirus
• Leukine (sargramostim), which is used to reduce chemotherapy-related complications in patients receiving treatment for acute myeloid leukemia
• Nipent (pentostatin), an injection that treats hairy cell leukemia
• Padcev (enfortumab vedotin-ejfv), which is used to treat certain patients with bladder and other urinary-tract cancers
• Rybrevant (amivantamab), a drug for the treatment of non-small cell lung cancer that harbors specific mutations

“People with Traditional Medicare and Medicare Advantage who use these drugs may, depending on other health coverage they may have, pay a reduced amount for their coinsurance during this specific quarter,” the CMS said in a statement. “For the quarter (of) April 1 to June 30, 2023, people with Medicare may experience coinsurance amounts that are lower than what they would have paid before the new law passed by as much as $1 - $372 per average dose.”

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