New Medicare rules and payment plans make expensive cancer drugs more affordable.
Starting this year, people on Medicare who need expensive cancer pills are finally getting some relief. In the past, even with Medicare coverage, cancer drug costs were sky high patients often having to shell out more than $10,000 a year just for their medicine. Thanks to new rules in the Inflation Reduction Act, or IRA, the most anyone on Medicare will pay out-of-pocket for their prescriptions each year is $2,000. That’s a big drop. But a recent study from the University of Pennsylvania found there’s an even better way to make these costs easier to manage. A voluntary program called the Medicare Prescription Payment Plan, or MPPP, lets patients break up that $2,000 into smaller monthly payments instead of paying it all at once.
Before this year, Medicare didn’t really protect patients from sky-high drug costs. People had to pay a deductible, then about a quarter of the drug’s price, and then a small percentage after they hit what’s called “catastrophic coverage.” With cancer drugs that can cost thousands each month, patients would still get stuck with a huge bill. In fact, for some drugs like enzalutamide, used for prostate cancer, people were paying more than $11,000 out-of-pocket each year. For a combo treatment like dabrafenib and trametinib for melanoma, the cost shot up to over $20,000. And a lot of that money was due upfront, in the first few months of the year. Not surprisingly, when faced with bills like that, many patients—about 42% according to earlier research—simply stopped taking their medication.
The new $2,000 cap under the IRA definitely makes a difference. Across the ten medications the Penn researchers looked at, out-of-pocket cancer drug costs dropped between 82% and 90%. But there’s a catch: even though the total is much lower, that full $2,000 could still be due when patients fill their first prescription in January. For many people, that’s still too much to handle at once. That’s where the new payment option comes in. The MPPP lets patients spread the $2,000 across the whole year, making monthly payments of about $167. If someone signs up in January, they’ll have the full 12 months to stretch out their payments, keeping their costs predictable and much easier to budget.
The idea behind MPPP actually came from the same Penn research team that ran the study. They say timing is really important here. Patients need to sign up early in the year to get the biggest benefit. Doctors and cancer clinics will play a big part too. They’ll need to make sure their Medicare patients know about this program and how it can help them stay on their medications without the shock of a big cancer drug costs all at once.
The study looked at real-world drugs used by thousands of cancer patients every year. These are not rare or experimental treatments—they are everyday cancer medications that keep people alive and well. Without help, these drugs were simply too expensive for many. While the IRA’s out-of-pocket cap is a major step forward, the option to spread costs monthly could be the thing that keeps even more people from giving up on treatment.
No outside money funded this study, and the lead researcher, Jalpa Doshi, has worked with some drug companies before, but the research was done independently. The findings are now published in JCO Oncology Practice.
For cancer patients on Medicare, the new changes and the new payment plan could mean the difference between being able to stick with treatment or being forced to stop. It’s a big deal, and the earlier patients hear about it and act, the better.
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