Hepatitis C: Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019

Published: Feb 01, 2019 

The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019

Juliette Cubansk, Wyatt Koma, and Tricia Neuman

Medicare Part D enrollees without low income subsidies can expect to pay thousands of dollars out of pocket for a single specialty tier drug in 2019. For many specialty tier drugs, the majority of these costs will occur in the catastrophic phase of the benefit.

Part D enrollees can face thousands of dollars in annual out-of-pocket costs if they take expensive drugs, despite having catastrophic coverage. Expected annual out-of-pocket costs in 2019 average $8,109 across the 28 specialty tier drugs covered by some or all plans in this analysis. For 28 of the 30 studied specialty drugs used to treat four health conditions—cancer, hepatitis C, multiple sclerosis (MS), and rheumatoid arthritis (RA)—expected annual out-of-pocket costs for a single drug in 2019 range from $2,622 for Zepatier, a treatment for hepatitis C, to $16,551 for Idhifa, a leukemia drug. Two of the 30 drugs are not covered by any plan in our analysis. (See Tables 1 and 2 for drug-specific cost and coverage information.)

Figure 3: While out-of-pocket costs for some hepatitis C drugs have decreased since their introduction, Part D enrollees still pay thousands of dollars for these medications

Read More: https://www.kff.org/report-section/the-out-of-pocket-cost-burden-for-specialty-drugs-in-medicare-part-d-in-2019-findings/