The study, which examined CMS data for 250,000 Medicare rheumatoid arthritis patients, found beneficiaries often have higher out-of-pocket costs for Part D-covered rheumatoid arthritis drugs compared to arthritis drugs covered in fee-for-service Medicare under Part B.
The average annual out-of-pocket costs for Part B-covered arthritis drugs was $1,380 in 2016, versus $1,990 for Part D-covered arthritis drugs. Avalere said the numbers account for patients with supplementary coverage or low-income subsidies.
The findings come as the federal government is considering moving some biologic therapies that treat rheumatoid arthritis from Part B to Part D. Medicare currently covers these biologics under both. Drugs are covered under Part B if they are physician-administered and Part D if self-administered.
Avalere said the proposed shift could leave many Medicare rheumatoid arthritis patients with higher out-of-pocket costs unless there is more policy change to lower cost sharing under Part D.
Read more about the study here.
More articles on healthcare finance:
Northwell Health seeks to raise $530M for capital improvements, initiatives
New Jersey hospital to pay $550K annually to city after challenge of tax-exempt status
Hospitals slow in cost-cutting efforts, survey finds
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.