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UPJ INSIGHT Impact of Inflation Reduction Act on Out-of-Pocket Costs for Medicare Beneficiaries With Prostate Cancer
By: Brian D. Cortese, BS, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Wharton School of Business, University of Pennsylvania, Philadelphia; Stacie B. Dusetzina, PhD, Vanderbilt University Medical Center, Nashville, Tennessee; Bashir Al Hussein Al Awamlh, MD, Vanderbilt University Medical Center, Nashville, Tennessee; David F. Penson, MD, MPH, Vanderbilt University Medical Center, Nashville, Tennessee; Sam S. Chang, MD, MBA, Vanderbilt University Medical Center, Nashville, Tennessee; Daniel A. Barocas, MD, MPH, Vanderbilt University Medical Center, Nashville, Tennessee; Amy N. Luckenbaugh, MD, Vanderbilt University Medical Center, Nashville, Tennessee; Kristen R. Scarpato, MD, Vanderbilt University Medical Center, Nashville, Tennessee; Kelvin A. Moses, MD, PhD, Vanderbilt University Medical Center, Nashville, Tennessee; Ruchika Talwar, MD, Vanderbilt University Medical Center, Nashville, Tennessee | Posted on: 25 Oct 2023
Cortese BD, Dusetzina SB, Al Hussein Al Awamlh B, et al. Estimating the impact of the Inflation Reduction Act on the out-of-pocket costs for Medicare beneficiaries with advanced prostate cancer. Urol Pract. 2023;10(5):476-483.
Study Need and Importance
Although combination systemic therapy treatment regimens for metastatic, hormone-sensitive prostate cancer have been effective at reducing mortality, both clinician-administered (Part B) and self-administered (Part D) medications can cause financial toxicity for patients. In 2025, the Inflation Reduction Act (IRA) will limit out-of-pocket spending for self-administered (Part D) drugs to $2,000. Herein, we compare out-of-pocket spending for common treatment regimens for advanced prostate cancer before and after implementation of the IRA.
What We Found
We found that when beneficiaries lack supplemental Part B coverage, they could be responsible for a 20% coinsurance leading to an out-of-pocket contribution ranging from $150 to $600. Currently, out-of-pocket costs for Part D beneficiaries ranged from $464 to $11,336 per year. Under the IRA, annual out-of-pocket costs for 2 regimens remained the same: androgen deprivation therapy (ADT) and docetaxel, as well as for ADT, abiraterone, and prednisone. However, annual savings for regimens that included branded self-administered drugs subject to the $2,000 out-of-pocket cap were estimated to be $9,336 (79.2%) for ADT and apalutamide; $9,036 (78.7%) for ADT and enzalutamide; and $8,480 (76.5%) for ADT, docetaxel, and darolutamide.
Limitations
Our analysis uses a standard benefit design with no deductible that may not apply to all beneficiaries, assuming ADT in our study consists of clinician-administered leuprolide 45 mg intramuscular q 6 months despite emergence of relugolix as an equally efficacious self-administered option, using 2021 volume data to estimate the number of beneficiaries impacted, and only including 1 triple-agent regimen with emerging evidence (see Figure).
Interpretation for Patient Care
The $2,000 spending cap introduced by the IRA may decrease out-of-pocket costs and reduce financial toxicity due to advanced prostate cancer treatment. We aim to highlight the financial impact of the IRA on patient out-of-pocket costs for patients on combination systemic therapy for advanced prostate cancer.
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