Medicare part d copay plus#

John was prescribed a life-saving anticancer medication with an annual list price of approximately $167,000.

Medicare part d copay plus#

In 2017, Doshi and colleagues proposed a policy solution (later discussed in a 2018 Health Affairs Forefront article) to address this problem: an annual Part D out-of-pocket cap, plus monthly caps to distribute these costs more evenly throughout the year, also known as “smoothing.” The benefits of a combined annual cap and smoothing were further illustrated in a case study describing John Doe, a 73-year-old man living with chronic myeloid leukemia, a form of blood cancer. Research has shown that patient out-of-pocket costs under Part D are “ too much and (occurred) too soon” in the calendar year and are associated with high rates of prescription abandonment, reductions and delays in treatment initiation treatment interruptions and earlier discontinuation of specialty drug treatments. no annual cap) results in prohibitive out-of-pocket costs, especially early in the year.

High cost sharing (25%-33% coinsurance) until a catastrophic spending threshold is reached after which patients pay 5% coinsurance for the remainder of the year (i.e. This is particularly true for patients requiring high-cost specialty drugs. Since the implementation of Medicare Part D in 2006, a growing number of beneficiaries have faced insurmountable out-of-pocket costs for their medications. Setting the Stage: Why “Smoothing” is Necessary Smoothing has the potential to be transformative for patients with high out-of-pocket drug costs, but its success will depend on how the Centers for Medicare and Medicaid Services (CMS) and other stakeholders design, promote, and implement the program.

In contrast to the current Part D benefit structure where out-of-pocket costs are typically frontloaded at the start of each calendar year, the “smoothing” option will allow Medicare beneficiaries to spread their out-of-pocket prescription costs more evenly with monthly installments. However, an equally important provision in the legislation has been overlooked: giving beneficiaries the option of “smoothing” their Part D out-of-pocket costs starting in 2025. Media coverage has largely focused on one Medicare reform enacted through the IRA-a $2,000 limit on annual Part D out-of-pocket prescription costs starting in 2025. The Inflation Reduction Act (IRA) of 2022 marks the first major overhaul of the Medicare Part D prescription drug benefit in over a decade. Cross-posted with permission from Health Affairs Forefront.