Here’s How Out-of-pocket Spending for RA Biologic Drugs Was Affected by Medicare Part D

A new study assessed whether the coverage gap closure in Medicare Part D between 2010 and 2019 decreased annual out-of-pocket costs for biologic drugs used to treat rheumatoid arthritis (RA).

“The closure of the Medicare Part D coverage gap from 2010 to 2019 was intended to help decrease out-of-pocket costs for beneficiaries, especially those taking high-cost drugs. However, yearly increases in list prices and the introduction of newer and more expensive drugs may have limited savings for beneficiaries,” the researchers explained.

To that end, they conducted a cross-sectional analysis of data from the Medicare Formulary and Pricing Files for quarter one of each calendar year from 2010 through 2019 for 17 RA biologic drug and strength combinations. The main exposure was Medicare Part D plan design and drug price per year. The primary outcome was the expected yearly out-of-pocket costs for a single year of treatment.

Each year, list prices increased for every product assessed in the drug and strength combinations. There were six drugs available for the whole study period; the mean increase for these drugs was 160%. Among the six drugs available for the entirety of the study, the projected mean annual out-of-pocket costs were 34% lower in 2011 than 2010 (2010: $6,108 vs. 2011: $4,026); however, they were only 21% lower by 2019 ($4,801) due to yearly list prices increases. There were four products with higher out-of-pocket costs in 2019 than the first year available that entered the market between 2011 and 2015. The percentage of money spent in the catastrophic phase increased each year for all products studied; the mean was 22% higher in 2019 than in 2010 or the first year the drug was available.

The study results were published in JAMA Network Open.

“As the coverage gap is now considered closed, our results suggest a need for out-of-pocket maximums in the catastrophic phase to limit older Americans’ yearly financial burden and allow them to better estimate their annual drug costs. In the interim, however, limiting the allowed annual increase in list prices and capping out-of-pocket costs for Medicare Part D enrollees may be associated with decreased financial burden for patients receiving biologic therapies,” the researchers summarized.