"Within the Inflation Reduction Act, there is a provision that will cap the out-of-pocket contribution for Medicare beneficiaries, dropping to $3250 in 2024, as well as $2,000 in 2025," says Brian Cortese.
In this interview, Brian Cortese highlights the background and findings from the study, “Estimating the impact of the Inflation Reduction Act on the out-of-pocket costs for Medicare beneficiaries with advanced prostate cancer,” for which he served as the lead author. Cortese is a medical student and business student at the Perelman School of Medicine and the Wharton School of Business at the University of Pennsylvania in Philadelphia.
Could you describe the background for this study?
The inflation Reduction Act that was passed back in 2022 is the largest piece of legislation that's touching the healthcare space since the Patient Protection and Affordable Care Act also known as Obamacare. Within the Inflation Reduction Act, there's a provision that is looking at the prescription drug benefits, so this is Medicare Part D. This is focusing on self-administered drugs. It's an opt-in program, typically oral medications, such as blood pressure, diabetes, etc. Within the Inflation Reduction Act, there is a provision that will cap the out-of-pocket contribution for Medicare beneficiaries, dropping to $3250 in 2024, as well as $2,000 in 2025.
The background was that as someone who wants to pursue urology and is interested in health policy, we wanted to create a very practical examination of how this prescription drug benefit could impact Medicare beneficiaries. We looked at metastatic prostate cancer, which has a host of drugs that are able to treat it. However, some of them are still very expensive, because they’re brand name, so we wanted to look at practically, how could this new benefit design and the Inflation Reduction Act, help Medicare beneficiaries being treated for advanced prostate cancer?
What were some of the notable findings? Were any of these surprising for you and your coauthors?
So, we created these drug regimens based off of the American Urological Association guidelines for treating advanced prostate cancer. Combinations of drugs, such as something that you use for androgen deprivation therapy [and] then you have some sort of oral medication, which is what we were focusing on. It was interesting to know that even recently, a drug called abiraterone [and] the brand name for that is Zytiga, it recently became generic. It was pretty insightful to see how much the out-of-pocket costs decreased after it became generic, just off the bat. Our model showed that this drug, abiraterone, was not affected by the out-of-pocket maximum, because the out-of-pocket would be less than that $2,000 anyways. So, that's 1-fold, [that] certain standards of care, that are very accepted for metastatic prostate cancer won't necessarily be affected by this, which is a great thing, in the sense of we have an option that is low cost enough.
The second insight was that for brand name drugs, so there's 3 brand name drugs on the market. I know that generics have enzalutamide, darolutamide, and apalutamide. Some of these can be upwards of $8500 to nearly $10,000 per year, based off of current Part D prices. Just showing that there can be significant cost savings for these drugs implementing this new out-of-pocket maximum. We weren't necessarily surprised that we could get the savings; I think we were really surprised about the magnitude of those savings for each beneficiary. As I mentioned, it's somewhere around $8000 to $9,000 per year per beneficiary.
This transcription has been edited for clarity.