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Specialty Drugs Come With Steep Price Tag

Specialty-tier drugs, including biologics, account for nearly half of all medication spending by Medicare Part D patients. High out-of-pocket costs for these patients is a major concern.

A new Kaiser Family Foundation analysis examined the high out-of-pocket cost burden for Medicare enrollees taking specialty medications. For the majority of these medications, costs will occur above the catastrophic threshold, translating to $5,444 in out-of-pocket costs in the catastrophic phase alone.

Specialty drugs account for nearly half of overall medicine spending and amount to more than 20% of total Part D spending.

The researchers specifically calculated the expected annual 2019 out-of-pocket costs for 30 specialty tier drugs across four conditions: hepatitis C virus (HCV), multiple sclerosis (MS), cancer, and rheumatoid arthritis (RA). They found that the annual out-of-pocket costs are expected to be higher in 2019, on average, for eight of the 10 specialty drugs (compared with 2016).

For 28 of the 30 specialty drugs covered by some or all plans, out-of-pocket costs in 2019 will average $8,109. The researchers also reported that coverage varied widely for many of these specialty medications, reflecting a broad spectrum of out-of-pocket costs across the four conditions and 28 specialty tier drugs analyzed.

The authors calculated that:

Expected annual out-of-pocket costs for HCV medications exceed $2,000, with the highest at $6,338 for Harvoni (ledipasvir/sofosbuvir).

Expected annual out-of-pocket costs in 2019 for MS range from $6,507 for Avonex (interferon beta-1a) to $7,409 for glatiramer acetate.

Expected annual out-of-pocket costs in 2019 for RA range from $4,372 for Kevzara (sarilumab) to $5,471 for Humira (adalimumab).

Patients taking cancer medications are most likely to face higher out-of-pocket costs in 2019 than other diseases, with out-of-pocket costs exceeding $8,000, and most of this spending is above the catastrophic threshold.

For specialty tier drugs that are not covered, the authors estimated annual costs in Part D are at least 10 times higher than when covered.

Jack Cush, MD, is the director of clinical rheumatology at the Baylor Research Institute and a professor of medicine and rheumatology at Baylor University Medical Center in Dallas. He is the executive editor of A version of this article first appeared on RheumNow, a news, information and commentary site dedicated to the field of rheumatology. Register to receive their free rheumatology newsletter.