Proposed Caps and Lower Cost Sharing Requirements Will Lower Patient Part D Out-of-Pocket Spending

June 19, 2019

ASCO submitted comments to the House Ways and Means and Energy and Commerce committees on draft legislation to address rising out-of-pocket costs in the Medicare Part D program. The draft legislation proposes capping out-of-pocket costs for Part D beneficiaries. The society supports such caps and suggests other ways to reduce out-of-pocket costs for Part D beneficiaries with cancer including lower patient cost sharing requirements for self-administered cancer treatments and addressing unnecessary costs caused by utilization management policies.

The society shares the committees’ concerns about the increasing out-of-pocket costs facing Part D beneficiaries. Financial toxicity is a real issue for patients with cancer that can increase a patient’s likelihood to abandon treatment or become noncompliant with his or her treatment plan, according to a study in the Journal of Clinical Oncology.

ASCO’s comments assert that utilization management policies such as step therapy and moving vital cancer drug treatments into specialty tiers are contributing to the problem of rising out-of-pocket costs for cancer care. The society has long been concerned that step therapy not only jeopardizes patient health and access to care, but it also forces patients to pay out-of-pocket costs for extra medications before they can access the treatment that their provider believes is best for them, while specialty tiers require patients to pay a higher percentage of the cost of a drug out-of-pocket compared to generic or preferred-brand drugs.

The society strongly supports efforts to reduce out-of-pocket costs for Medicare beneficiaries with cancer and applauds the committees for making this issue a priority. ASCO will continue to share its perspective with policymakers to help improve access to high-quality cancer care for all Americans.

Read the full letter.

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