Abstract

Objectives

To estimate changes in true out-of-pocket (TrOOP) spend from implementation of a $2000 cap for outpatient prescriptions as authorized by the 2022 Inflation Reduction Act (IRA) among Medicare Part D beneficiaries who received a diagnosis of cancer.

Methods

Medicare beneficiaries who received a diagnosis of cancer 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 expenditures using previously published methods. Total annual TrOOP spend per beneficiary was estimated under 2 scenarios: (1) 2025 Part D design expected without any IRA policies implemented and (2) IRA design with a $2000 TrOOP cap. We reported the proportion of beneficiaries who would experience TrOOP spend changes with the cap and estimated differences in TrOOP spend for these individuals.

Results

An estimated 42% of Part D beneficiaries with a diagnosis of cancer were predicted to have annual TrOOP spend of more than $2000 without the Part D cap. With the cap, these beneficiaries were expected to experience an average annual reduction of $8486 in TrOOP spend. Among these beneficiaries, with the TrOOP cap, those with hematologic cancers were expected to experience the greatest reduction ($10 846/beneficiary).

Conclusions

Implementation of a Part D $2000 cap is expected to generate meaningful reduction in TrOOP spend for high-cost Medicare Part D beneficiaries who received a diagnosis of cancer.