Estimated Impact of the Inflation Reduction Act on Out-of-Pocket Spend Among Medicare Part D Beneficiaries with Cancer
Moderator
Aryana Sepassi, MS, PharmD, University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA, United States
Speakers
Nico Gabriel; Jason Zell; A Mark Fendrick, MD; Sean D Sullivan, PhD, University of Washington, Seattle, WA, United States; Inma Hernandez, PhD, UCSD, La Jolla, CA, United States
OBJECTIVES: To estimate savings from implementation of a $2,000 cap on true “out-of-pocket” (TrOOP) spending for outpatient prescriptions as authorized by the 2022 Inflation Reduction Act (IRA) among Medicare Part D beneficiaries diagnosed with cancer.
METHODS: Medicare beneficiaries with a cancer diagnosis and at least one Part D claim for a prescription drug to treat cancer in 2021 were identified from a 5% random sample of beneficiaries. Part D drug expenditures were extracted and adjusted to 2025 prices using previously published methods. Estimated total annual TrOOP spend per beneficiary was estimated under two scenarios: 1) 2025 Part D design expected without the IRA; and 2) IRA design, including a $2,000 TrOOP cap. We reported the proportion of beneficiaries who would see decreases in TrOOP with IRA, and, for those who did, estimated TrOOP savings.
RESULTS: An estimated 48% of Part D beneficiaries with cancer were estimated to have annual TrOOP spend above $2,000 without the IRA. For these beneficiaries, annual TrOOP spend averaged $9,283/beneficiary without the Part D TrOOP cap. With the cap, these beneficiaries were expected to save $7,283 annually in TrOOP spend. Among these beneficiaries, with the TrOOP cap, those with hematologic cancers realized the greatest savings at an estimated $10,351 TrOOP saved per beneficiary. Without the IRA TrOOP cap, 75% of total TrOOP spend for these beneficiaries was associated with cancer medication claims. With the IRA TrOOP cap, this TrOOP spend was reduced to 25%.
CONCLUSIONS: Implementation of a Part D $2,000 TrOOP cap is expected to generate meaningful savings for Medicare Part D beneficiaries diagnosed with cancer and high TrOOP spend.
METHODS: Medicare beneficiaries with a cancer diagnosis and at least one Part D claim for a prescription drug to treat cancer in 2021 were identified from a 5% random sample of beneficiaries. Part D drug expenditures were extracted and adjusted to 2025 prices using previously published methods. Estimated total annual TrOOP spend per beneficiary was estimated under two scenarios: 1) 2025 Part D design expected without the IRA; and 2) IRA design, including a $2,000 TrOOP cap. We reported the proportion of beneficiaries who would see decreases in TrOOP with IRA, and, for those who did, estimated TrOOP savings.
RESULTS: An estimated 48% of Part D beneficiaries with cancer were estimated to have annual TrOOP spend above $2,000 without the IRA. For these beneficiaries, annual TrOOP spend averaged $9,283/beneficiary without the Part D TrOOP cap. With the cap, these beneficiaries were expected to save $7,283 annually in TrOOP spend. Among these beneficiaries, with the TrOOP cap, those with hematologic cancers realized the greatest savings at an estimated $10,351 TrOOP saved per beneficiary. Without the IRA TrOOP cap, 75% of total TrOOP spend for these beneficiaries was associated with cancer medication claims. With the IRA TrOOP cap, this TrOOP spend was reduced to 25%.
CONCLUSIONS: Implementation of a Part D $2,000 TrOOP cap is expected to generate meaningful savings for Medicare Part D beneficiaries diagnosed with cancer and high TrOOP spend.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR36
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Pricing Policy & Schemes
Disease
SDC: Geriatrics, SDC: Oncology