Median estimated out-of-pocket costs for 30 specialty-tier drugs in 2019

Medicare Part D beneficiaries with serious health conditions and not receiving low-income subsidies can expect to pay anywhere from $2,622 to $16,551 out of pocket for specialty-tier drugs this year, according to a Kaiser Family Foundation analysis.

For the analysis, researchers used data from the Medicare Plan Finder website last November and December to examine annual 2019 out-of-pocket costs for 30 specialty-tier drugs for cancer, hepatitis C, multiple sclerosis and rheumatoid arthritis. They looked at Medicare Part D plans that cover the drug, based on coverage in stand-alone prescription drug plans and costs at a pharmacy in ZIP code 21201 in Baltimore, Md.

That ZIP code approximates prescription drug plan costs nationally because 24 of the 25 Medicare Part D prescription drug plans in that ZIP code are offered nationally or near nationally. Researchers said prescription drug plans also typically use the same formulary and the same specialty-tier coinsurance rate nationally, making the analysis applicable to a majority of U.S. Medicare Part D prescription drug plan enrollees.

While researchers looked at 30 specialty-tier drugs, two of them, Gleevec and Viekira Pak, are not covered by any plan in 2019.

Here is the median annual out-of-pocket cost for the drugs, based on the  foundation's analysis:

Cancer

1. Zytiga - $8,181

2. Erleada - $8,586

3. Venclexta - $8,712

4. Nerlynx - $8,842

5. Imatinib mesylate - $8,983

6. Verzenio - $9,164

7. Calquence - $10,175

8. Rubraca - $10,386

9. Alunbrig - $11,014

10. Zejula - $11,625

11. Rydapt - $11,830

12. Kisqali - $12,145

13. Revlimid - $14,461

14. Idhifa - $16,551

15. Gleevec – N/A

Hepatitis C

16. Zepatier - $2,622

17. Harvoni - $6,338

18. Mavyret - $3,520

19. Epclusa - $5,283

20. Vosevi - $5,306

21. Sovaldi - $5,633

22. Viekira Pak – N/A

Rheumatoid arthritis or multiple sclerosis

23. Kevzara - $4,372

24. Orencia - $5,207

25. Enbrel - $5,465

26. Humira - $5,471

27. Avonex - $6,507

28. Tecfidera - $6,595

29. Copaxone - $6,672

30. Glatiramer acetate – $7,409

Access the full analysis findings here.

 

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