Commercial insurance enrollees pay less for ultra-expensive drugs than Medicare Part D members: Study

Medicare Part D beneficiaries that don't receive low-income subsidies spend 2.5 times more out-of-pocket on "ultra-expensive" drugs than those with commercial insurance, a study published May 26 in JAMA Health Forum found. 

Researchers at Baltimore-based Johns Hopkins Bloomberg School of Public Health and HHS compared claims data for Part D beneficiaries and commercially insured individuals aged 45 to 64 years who received ultra-expensive drugs between 2013 and 2019. 

Ultra-expensive drugs cost more per beneficiary per year than the U.S. gross domestic product per capita in that year, according to the study. 

In 2019, beneficiaries with commercial insurance paid an average of $1821 out-of-pocket for ultra-expensive drugs, and Part D beneficiaries paid $4478. 

Medicare Advantage beneficiaries paid less than standalone Part D plan members, paying $4301 out-of-pocket for ultra-expensive drugs, compared to $4575 for Part D beneficiaries. 

Provisions of the Inflation Reduction Act capping out-of-pocket Part D costs at $2000 per year could save Medicare beneficiaries taking ultra-expensive drugs thousands of dollars each year, the study's authors wrote. The price cap is set to take effect in 2025. 

Read more here. 

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