Medicare proposal could increase out-of-pocket expenses for rheumatoid arthritis patients

A proposal to move Medicare Part B drugs into Part D could leave rheumatoid arthritis patients on the hook for more out-of-pocket costs, according to a study from Avalere.

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.


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