11/17/2021

Assessment of Out-of-Pocket Costs With Rebate Pass-through for Brand-name Cancer Drugs Under Medicare Part D

Payers receive confidential rebates from pharmaceutical manufacturers, which allow for lower premiums but are not typically reflected in drugs’ list prices or patients’ out-of-pocket costs. In November 2020, the US Department of Health and Human Services published a final rule requiring rebates in Medicare Part D to be “passed through” to point-of-sale prices instead of being retained by plans.¹ Implementation has been delayed owing to concerns about projected increases in beneficiary premiums and federal spending.^2,3 Unlike other drug classes (eg, hepatitis C drugs), cancer drugs are both highly costly and often have small or no rebates in Part D (averaging 2% overall⁴), in part because Part D plans are required to cover them.⁵ In this cross-sectional study, we examined out-of-pocket costs with and without rebate pass-through for cancer drugs in Part D.

READ MORE