Many Medicare patients don't fill prescriptions for specialty drugs, study finds

Many Medicare beneficiaries who don't qualify for low-income subsidies aren't filling prescriptions for expensive specialty drugs used to treat serious health issues, a study published in Health Affairs found.

Researchers at Nashville, Tenn.-based Vanderbilt University Medical Center analyzed prescribing records and fill data for 17,076 prescriptions covering expensive medications used to treat cancer, hepatitis C, immune system disorders and high cholesterol. The prescriptions were issued to fee-for-service Medicare patients enrolled in Part D drug benefits and treated at 11 U.S. health systems between 2012 and 2018. 

Medicare beneficiaries who received low-income subsidies were nearly twice as likely to fill prescriptions for crucial medications compared to those without subsidies. 

Thirty percent of patients without subsidies did not fill prescriptions for cancer drugs, 22 percent didn't fill prescriptions for hepatitis C treatments and more than 50 percent didn't fill medications for immune disorders.

In 2021, more than 70 percent of Medicare Part D beneficiaries did not qualify for low-income subsidies. 

"These beneficiaries face very high costs when starting a drug and unlimited out-of-pocket spending over the year," lead author Stacie Dusetzina, PhD, Ingram associate professor of cancer research and associate professor of health policy at Vanderbilt University Medical Center, said in an April 4 news release. 

"It is time for Congress to revise the Medicare benefit to make sure that beneficiaries can access the treatments that they need," she added.

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