Erin Trish, Jianhui Xu, and Geoffrey Joyce found that average annual spending among Medicare beneficiaries taking one of the eight highest cost specialty drugs increased from $18,335 to $33,301 from 2008-2012, and the share of spending while in the catastrophic coverage phase increased from 70 to 80 percent. Though provisions in the Affordable Care Act reduced the burden patients face while in the Part D donut hole, out-of-pocket expenditures in the catastrophic coverage phase have nearly canceled this out for these beneficiaries, according to the analysis in Health Affairs. These findings raise questions as to whether a true out-of-pocket spending cap is needed in Part D.
Citation: Trish, E., Xu, J., & Joyce, G. (2016). Medicare beneficiaries face growing out-of-pocket burden for specialty drugs while in catastrophic coverage phase. Health Affairs, 35(9), 1564-1571.