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Cost Of Cancer Pills Can Be Hard For Medicare Patients To Swallow

Taking a pill for cancer can cost patients more than getting chemotherapy by IV.
Taking a pill for cancer can cost patients more than getting chemotherapy by IV.

If you've got cancer, chances are you'd rather take a pill to fight the cancer cells than sit for hours hooked up to an IV line as the chemotherapy drips slowly into you.

The difficulty is, many of the new cancer pills, which often target cancer cells for destruction but leave healthy cells intact, are pricey, costing tens of thousands of dollars for a course of treatment. And how some insurers pay for treatments means that pills can wind up costing a patient more than chemotherapy given by IV.

Nineteen states and the District of Columbia now require private health plans to cover cancer-fighting pills, if they're available, to the same degree and without charging patients more than they would for traditional intravenous infusion therapy, according to the National Patient Advocate Foundation.

So, for example, a health plan that has a $1,500 limit on out-of-pocket spending for outpatient services like IV chemotherapy can't charge more than that annually for their treatment pills.

But Medicare beneficiaries don't benefit from these laws.

They're tied to whatever coverage they have through their Medicare prescription drug plan, which may or may not provide affordable coverage for their anti-cancer pills, if they're covered at all.

High drug costs are a problem for all patients, but those on fixed incomes can be hit especially hard.

One study by researchers at Avalere Health found that about 46 percent of Medicare beneficiaries faced more than $500 in cost sharing for their initial anti-cancer drug prescription. Sixteen percent of Medicare beneficiaries didn't fill their initial prescriptions for anti-cancer pills, compared with 9 percent of patients with private insurance.

Under the Medicare Part D drug benefit, beneficiaries are responsible for paying 100 percent of their prescription drug costs from the time they reach $2,930 in total drug spending until they hit the $4,700 maximum out-of-pocket limit for the year. Once they're through that so-called doughnut hole in coverage, they're usually responsible for 5 percent of their drug costs.

A new lung cancer drug might cost $10,000 a month. "It's a real problem for people on Social Security who don't have any other income," says Len Lichtenfeld, deputy medical director for the American Cancer Society.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Michelle Andrews