Medicare Part D 2016 = Expect HUGE out-of-pocket costs with Prescription Drugs

4 Dec

Medicare Part D 2016 = Expect HUGE out-of-pocket costs with your Prescription Drugs

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Although a Small Share of Medicare Part D Enrollees Take Specialty Drugs, A New Analysis Finds Those Who Do Can Face Thousands of Dollars in Out-of-Pocket Drug Costs Despite Plan Limits on Catastrophic Expenses
Some Medicare Part D enrollees can expect to pay thousands of dollars out-of-pocket for a single specialty drug in 2016, even though Part D plans provide substantial protection against catastrophic costs, according to a new analysis from the Kaiser Family Foundation. The findings illustrate how high prescription drug prices, one of the public’s top health care concerns, pose a financial challenge not only for Medicare and other federal health programs but for people on Medicare as well.

For 12 specialty drugs used to treat four health conditions—hepatitis C, multiple sclerosis, rheumatoid arthritis, and cancer—Part D beneficiaries face at least $4,000 and as much as nearly $12,000 in out-of-pocket costs in 2016 for one drug alone. In 2014, 2 percent of Part D enrollees used these and other specialty tier drugs, according to the Centers for Medicare and Medicaid Services, though not all will face out-of-pocket costs as high as those identified in the analysis. The analysis by researchers at Georgetown University and the Kaiser Family Foundation also found that a significant share of the out-of-pocket costs for such drugs, defined by Medicare as drugs that cost more than $600 per month, can be incurred even after enrollees’ drug spending reaches the drug benefit’s catastrophic threshold, which is intended to protect against high costs but is not an absolute limit on out-of-pocket spending.

John Chandler

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