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. 2023 Sep;10(5):467-475.
doi: 10.1097/UPJ.0000000000000421. Epub 2023 Jun 22.

Out-of-Pocket Costs for Prostate Cancer Medications Substantially Vary by Medicare Part D Plan: An Online Tool Presents an Opportunity to Mitigate Financial Toxicity

Benjamin Pockros  1 , Christina Shabet  2 , Kristian Stensland  1 , Lindsey Herrel  1
Affiliations

Out-of-Pocket Costs for Prostate Cancer Medications Substantially Vary by Medicare Part D Plan: An Online Tool Presents an Opportunity to Mitigate Financial Toxicity

Benjamin Pockros et al. Urol Pract. 2023 Sep.

Abstract

Introduction: Patients with advanced prostate cancer are frequently prescribed enzalutamide or abiraterone, often requiring high out-of-pocket costs. Many of these patients are insured through Medicare and have an option to select among 54 different Part D drug plans. However, less than 30% of patients report comparing costs before selecting a plan. An online Part D plan navigator is publicly available and allows patients to compare estimated out-of-pocket prescriptions costs. In this study, we examine the variability of out-of-pocket costs based on available Part D drug plans for patients with prostate cancer and demonstrate how an online tool could save patients thousands of dollars.

Methods: We identified drug plans available for selection in 2023 using the online Medicare Part D Plan Finder. We sampled plan options for 12 different zip codes within the United States. A university-sponsored specialty cancer pharmacy and online mail-order pharmacy were included for comparison. We identified out-of-pocket costs for enzalutamide and abiraterone based on all Part D plans available for selection.

Results: On average, 24 Part D drug plans were available for each zip code. Median annual out-of-pocket costs were $11,626 for enzalutamide and $9,275 for abiraterone. The range of annual out-of-pocket costs were $9,854 to $13,061 for enzalutamide and $1,379 to $13,274 for abiraterone. Within certain zip codes, potential out-of-pocket cost savings were $2,512 for enzalutamide and $9,321 for abiraterone. Median difference of out-of-pocket cost between enzalutamide and abiraterone was $8,758.

Conclusions: Out-of-pocket costs vary considerably across Part D drug plans. The Medicare Part D Plan Finder is a simple and effective tool to identify affordable drug plans. Guidance on plan selection could save patients thousands of dollars and help mitigate the financial toxicity of treatment. Comprehensive cancer centers could include plan navigators as an essential component of treatment.

Keywords: Medicare Part D; financial stress; health expenditures; prescription fees; prostatic neoplasms.

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Conflict of interest statement

Disclosures: We declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Patients on Medicare have up to 27 Traditional Part D Plans to Compare.
Figure 2.
Figure 2.
Out-of-Pocket Costs for Abireratone among a sample of Part D Plans.
Figure 3.
Figure 3.
Out-of-Pocket Costs for Enzalutamide among a sample of Part D Plans.
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Carson D, Nyame YA. Carson D, et al. Urol Pract. 2023 Sep;10(5):475. doi: 10.1097/UPJ.0000000000000421.01. Epub 2023 Jul 5. Urol Pract. 2023. PMID: 37409953 No abstract available.

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