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UPJ INSIGHT Medicare Part D Plan Navigation Could Reduce Out-of-Pocket Costs of Prostate Cancer Medications

By: Benjamin Pockros, MD, MBA, University of Michigan, Ann Arbor; Christina Shabet, BSE, University of Michigan Medical School, Ann Arbor; Kristian Stensland, MD, MPH, MS, University of Michigan, Ann Arbor; Lindsey Herrel, MD, MS, University of Michigan, Ann Arbor | Posted on: 19 Sep 2023

Pockros B, Shabet C, Stensland K, Herrel L. Out-of-pocket costs for prostate cancer medications substantially vary by Medicare Part D plan: an online tool presents an opportunity to mitigate financial toxicity. Urol Pract. 2023;10(5):467-475.

Study Need and Importance

Oral androgen inhibitors for advanced prostate cancer, such as enzalutamide or abiraterone, are becoming increasingly prescribed by urologists for earlier stages of treatment and for longer durations of time. Patients insured by Medicare can select Part D drug plans that vary in cost-sharing models and coverage, resulting in highly variable out-of-pocket (OOP) costs. We examine the range of OOP costs associated with Part D plans for patients prescribed enzalutamide or abiraterone, and highlight an opportunity for patients to potentially reduce the financial toxicity of treatment.

What We Found

Patients have multiple Part D plans available for comparison, ranging from 19 (New York, New York) to 28 (Phoenix, Arizona). OOP costs substantially vary between Part D plans for both abiraterone and enzalutamide. Among all 12 cities included in this study, the median range of OOP costs for abiraterone between the most and least expensive Part D plan was $9,321 (see Figure). The median range of OOP costs for enzalutamide was $1,839. The online Part D plan comparison tool could save patients thousands of dollars on OOP prescription spending for both abiraterone and enzalutamide.

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Figure. Out-of-pocket costs for abiraterone among a sample of Part D plans (range $1,379 to $13,274). Patients have the right to select the cheapest plan available (lowest dot on the graph) every year during open enrollment season.

Limitations

This analysis is limited by only 2 advanced prostate cancer medications, and findings only apply for patients insured by Medicare. The study was performed during the 2022 open enrollment season. Plan availability and OOP estimates may vary in upcoming years.

Interpretation for Patient Care

The online Medicare Part D Plan Finder is a simple and free tool to help mitigate financial toxicity of cancer care in the United States. Open enrollment season for plan selection occurs annually from October 15 to December 7. Physicians should reach out to their patient panel during these weeks, emphasize that OOP drug costs can substantially vary between Part D plans, disseminate the link to www.medicare.gov/plan-compare, and encourage their patients to compare costs before selecting a new drug plan.

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