Another arbitrary difference: who qualifies for low-income subsidies under Part D. A single woman making the current median income, for instance, would not qualify for a Part D subsidy. If she was diagnosed with breast cancer and needed palbociclib, her cost for that drug alone would be nearly half her annual income, and that does not include premiums and other health care costs.
The high cost can mean foregoing treatment, stopping treatment early, or reducing spending on necessities such as food and housing. In fact, a recent study from Dr. Dusetzina and colleagues showed that for beneficiaries with cancer who do not receive subsidies under Part D, nearly 30% of initial prescriptions for specialty oncology drugs go unfilled.
Fortunately, that wasn’t the case for Dr. Dusetzina’s mother.
“Her cancer subtype is best treated with drugs covered under her medical benefit, and she has an out-of-pocket limit on that benefit,” she said. “That makes the financial difficulty less of a concern right now.”
But with a different subtype, it could have easily gone another way.
On Twitter, Dr. Dusetzina called for congressional action: “There is a lot going on now, but @SenateDems & @SenateGOP this needs to be fixed. #Medicare beneficiaries are counting on you to make sure that they can afford the drugs they need. We know that 1 in 3 people in #PartD don’t fill their cancer drugs. That is unacceptable.”
Dr. Dusetzina’s work is supported by the Commonwealth Fund. She reported relationships with the Institute for Clinical and Economic Review, the Laura and John Arnold Foundation, Leukemia and Lymphoma Society, National Academy for State Health Policy, and West Health Council, including grant funding/contracts and/or consulting work. She also serves as a commissioner for the Medicare Payment Advisory Commission (MedPAC).
A version of this article first appeared on Medscape.com.