Medicare Part D beneficiaries with serious health conditions and not receiving low-income subsidies can expect to pay anywhere from $2,622 to $16,551 out of pocket for specialty-tier drugs this year, according to a Kaiser Family Foundation analysis.
For the analysis, researchers used data from the Medicare Plan Finder website last November and December to examine annual 2019 out-of-pocket costs for 30 specialty-tier drugs for cancer, hepatitis C, multiple sclerosis and rheumatoid arthritis. They looked at Medicare Part D plans that cover the drug, based on coverage in stand-alone prescription drug plans and costs at a pharmacy in ZIP code 21201 in Baltimore, Md.
That ZIP code approximates prescription drug plan costs nationally because 24 of the 25 Medicare Part D prescription drug plans in that ZIP code are offered nationally or near nationally. Researchers said prescription drug plans also typically use the same formulary and the same specialty-tier coinsurance rate nationally, making the analysis applicable to a majority of U.S. Medicare Part D prescription drug plan enrollees.
While researchers looked at 30 specialty-tier drugs, two of them, Gleevec and Viekira Pak, are not covered by any plan in 2019.
Here is the median annual out-of-pocket cost for the drugs, based on the foundation's analysis:
Cancer
1. Zytiga - $8,181
2. Erleada - $8,586
3. Venclexta - $8,712
4. Nerlynx - $8,842
5. Imatinib mesylate - $8,983
6. Verzenio - $9,164
7. Calquence - $10,175
8. Rubraca - $10,386
9. Alunbrig - $11,014
10. Zejula - $11,625
11. Rydapt - $11,830
12. Kisqali - $12,145
13. Revlimid - $14,461
14. Idhifa - $16,551
15. Gleevec – N/A
Hepatitis C
16. Zepatier - $2,622
17. Harvoni - $6,338
18. Mavyret - $3,520
19. Epclusa - $5,283
20. Vosevi - $5,306
21. Sovaldi - $5,633
22. Viekira Pak – N/A
Rheumatoid arthritis or multiple sclerosis
23. Kevzara - $4,372
24. Orencia - $5,207
25. Enbrel - $5,465
26. Humira - $5,471
27. Avonex - $6,507
28. Tecfidera - $6,595
29. Copaxone - $6,672
30. Glatiramer acetate – $7,409
Access the full analysis findings here.
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