Patients with advanced prostate cancer are frequently prescribed enzalutamide or abiraterone, often requiring high out-of-pocket (OOP) costs. Many of these patients are insured through Medicare and have an option to select among 54 different Part D drug plans. However, less than 30% of patients report comparing costs before selecting a plan. An online Part D plan navigator is publicly available and allows patients to compare estimated OOP prescriptions costs. In this study, we examine the variability of OOP costs based on available Part D drug plans for patients with prostate cancer and demonstrate how an online tool could save patients thousands of dollars.
We identified drug plans available for selection in 2023 using the online Medicare Part D Plan Finder. We sampled plan options for 12 different ZIP codes within the United States. A university sponsored specialty cancer pharmacy and online mail-order pharmacy were included for comparison. We identified OOP costs for enzalutamide and abiraterone based on all Part D plans available for selection.
On average, 24 Part D drug plans were available for each ZIP code. Median annual OOP costs were $11,626 for enzalutamide and $9,275 for abiraterone. The range of annual OOP costs were $9,854 to $13,061 for enzalutamide and $1,379 to $13,274 for abiraterone. Within certain ZIP codes, potential OOP cost savings were $2,512 for enzalutamide and $9,321 for abiraterone. Median difference of OOP cost between enzalutamide and abiraterone was $8,758.
OOP costs vary considerably across Part D drug plans. The Medicare Part D Plan Finder is a simple and effective tool to identify affordable drug plans. Guidance on plan selection could save patients thousands of dollars and help mitigate the financial toxicity of treatment. Comprehensive cancer centers could include plan navigators as an essential component of treatment.
Urology practice. 2023 Jun 22 [Epub ahead of print]
Benjamin Pockros, Christina Shabet, Kristian Stensland, Lindsey Herrel
Department of Urology, University of Michigan, Ann Arbor, Michigan., University of Michigan Medical School, Ann Arbor, Michigan.