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High Cost of Oral Chemotherapy for Medicare Beneficiaries

By on May 24th, 2012
Filed: Advice, Caregivers, Disabled, Early Retirees, Medicare, Medicare, Seniors, Tips, You

In the fight against cancer, some patients may be faced with a very important decision about the method through which to receive their chemotherapy treatment: intravenous or oral?

Cancer pills have become the drug of choice to combat cancer cells rather than traditional intravenous chemotherapy; rather than visiting a hospital and being hooked up to an IV line, patients can now take oral chemotherapy in the comfort and convenience of their own homes. However, the costs of these cancer medications can be steep and depending on an individual’s insurance coverage for cancer treatments, can cost more than intravenous chemotherapy.

Since 2007, 19 states have passed mandates requiring insurers to cover cancer-fighting medication, if available, without charging patients more than what they would pay for intravenous chemotherapy, according to the National Patient Advocate Foundation.

However, these laws do not apply to Medicare beneficiaries.

Depending on what type of prescription drug coverage a Medicare beneficiary has, they may have little to no coverage for their cancer-fighting medications. Medicare beneficiaries are almost twice as likely to abandon their anti-cancer medications compared to those with commercial health insurance, according to a study by Avalere Health. Almost half of Medicare patients, taking cancer pills, faced cost-sharing greater than $500 for their medications

Medicare beneficiaries who take expensive medications like cancer pills are likely to fall into the Medicare Donut Hole, a coverage gap that occurs after their plan has paid $2,930 in medication costs up until the catastrophic coverage limit, which occurs after their out-of-pocket expenses for drugs on the plan’s formulary reach $4,700. In the Medicare Donut Hole, Medicare beneficiaries do receive a discount for generic and brand-name drugs; however, they must pay for all prescription drug costs out-of-pocket with no Medicare coverage of costs.

For Medicare beneficiaries who have fallen in the Medicare Donut Hole in 2012, their total annual out-of-pocket cost could amount to as much as $1,770.

Hence, it is important for Medicare beneficiaries, who are taking cancer medication, to ensure that the specific type, brand, and quantity of oral chemotherapy pills they need for treatment are covered by their prescription drug coverage. It is important to take your medication needs into account when comparing Medicare plan options and prescription drug coverage.

PlanPrescriber offers a Medicare plan comparison tool that allows you to customize your search results based on the prescription drugs that you take:

Compare Medicare Plans

NPR and Kaiser Health News also covered this story. You can read their report here.

* This information has not been reviewed or approved by Medicare

About Angela Chen


Angela Chen is a contributor and editor of the eHealth Medicare Blog and the Plan Prescriber Blog.

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