Medicare Part D beneficiaries face rising out-of-pocket costs for brand name drugs.

[Duaine]

Average expected costs more than double for some drugs

The study highlights the blockbuster blood thinner Eliquis (generic name: apixaban), which is taken by nearly 4 million Medicare beneficiaries and in 2024 had a list price of about $550 per month – within the typical range for branded, non-specialty drugs. The drug's mean pharmacy cost, which is similar to list price, grew by 22% between 2020 and 2024, while its estimated Part D rebates recently averaged 45%.

Over that time, Eliquis's average expected out-of-pocket costs for beneficiaries in stand-alone Part D plans more than doubled, from $46.76 to $102.32, as the share of plans using coinsurance for the drug increased from 10.7% to 75%.

For those in Medicare Advantage drug plans, however, the average expected out-of-pocket cost for Eliquis increased just slightly from $44.57 to $46.93 between 2020 and 2024. Only 5% of Medicare Advantage plans used coinsurance for Eliquis last year.

Meanwhile, average expected out-of-pocket costs in standalone Part D plans also increased substantially for other common preferred branded drugs. Like Eliquis, some saw increases of more than double, including:

• Trulicity (dulaglutide) for Type 2 diabetes, from $54.04 to $128.43
• Xarelto (rivaroxaban) for blood clots, from $46.54 to $ 94.50
• Ozempic (semaglutide) for Type 2 diabetes (and other indications), from $56.95 to $135.43.

"Medicare beneficiaries are often blindsided when they suddenly have to pay much more for the same drug they may have been taking for years," Trish said. "While Part D's new out-of-pocket cap will help beneficiaries over the full year, that initial sticker shock could make it harder for them to maintain their prescription, potentially leading to worse health outcomes."

[EXTERNAL LINK] - Medicare Part D beneficiaries face rising out-of-pocket costs for brand name drugs The Expe...

 

[axeman462]

are you trying to tell me that the price controls from the Inflation Reduction Act didn't help?

Shocking.

 

[Duaine]