Study: High Costs Prevent Medicare Beneficiaries from Filling Specialty Meds

Medicare patients who don’t receive subsidiaries often don’t fill their prescriptions for specialty medications, according to a new study in published in Health Affairs. Investigators found that beneficiaries receiving subsidies were nearly twice as likely to obtain the prescribed drug within 90 days as those without subsidies.

Among beneficiaries without subsidies, investigators found that 30% of prescriptions that were not filled were for anticancer drugs, 22% for hepatitis C treatments, and more than 50% for disease-modifying therapies for either immune system disorders or high cholesterol.

Stacie B. Dusetzina, Ph.D.

Investigators, led by Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center in Nashville, examined 17,076 new prescriptions issued between 2012 and 2018 for fee-for-service Part D beneficiaries from 11 health systems. In total, they found that almost half of the beneficiaries did not initiate the medication they were prescribed.

Those beneficiaries without subsidies are the most impacted by high costs, investigators found. For example, under the 2021 standard benefit, a prescription for the cancer drug Revlimid (lenalidomide) would cost more than $3,000 out-of-pocket, but less than $10 out of pocket for a person with a full low-income subsidy.

“The clinical implications of the levels of non-initiation that we observed are uncertain. Issuance of a prescription is evidence that a physician believes that a patient could benefit from a medication,” investigators wrote. “Given the high rates of non-initiation observed and the severity of illness that many of the drugs studied were prescribed to treat, it is likely that some patients were harmed by medication non-initiation.”

Investigators identified 17,076 prescriptions that met the criteria for high-price Part D specialty medications used to treat cancers (8,794 prescriptions and 6,990 people), hepatitis C (1,368 prescriptions and 1,210 people), immune system conditions (5,286 prescriptions and 4,275 people), or hypercholesterolemia (1,628 prescriptions and 1,364 people).

The proportion with full subsidies was highest among beneficiaries prescribed hepatitis C drugs (42.3%) and lowest among those prescribed specialty drugs for high cholesterol.

Investigators said that future studies should involve a greater number of sites and capture detailed clinical data available in health records and would follow patients for periods long enough to measure clinical outcomes.