Posted by Michael Wonder on 22 Dec 2016
High-cost, high-value oral specialty drugs: more evidence on the impact of cost sharing in Medicare Part D
20 December 2016 - In the closing moments of a recent clinic visit, a patient with progressive chronic lymphocytic leukaemia let out a sigh and said, “I’m in the donut hole; can’t this just wait until January?”
Minutes earlier, the reasons for initiating therapy had been discussed, as had the planned treatment approach using a novel immunotherapy alongside an old standby—chlorambucil. The patient had few questions about the therapy and seemed to easily accept the risks and benefits of the recommended treatment.
However, it was August, and medications for a number of other ailments had caused him to enter the coverage-gap phase of his Medicare Part D benefit. His concerns about the out-of-pocket costs were justified, because the first month’s fill for chlorambucil, a drug in use for more than 40 years, would cost him nearly $290.
