Patients with cancer incur significant out-of-pocket costs before their Medicare drug benefits activate, and due to those costs, many patients with chronic myelogenous leukemia (CML) delayed starting their treatment, a study published in the Journal of Clinical Oncology has shown.1

Tyrosine kinase inhibitors (TKIs), a type of oral cancer medication, have improved survival for patients with CML. However, these medications are costly, especially in the first month of treatment.

Medicare Part D requires patients to pay larger out-of-pocket costs for their medications up to approximately $4840 per year; after that, the patients pay 5% of the monthly drug costs for the remainder of the year. As a result, median annual out-of-pocket costs for a TKI drug can be as much as $8500, a Kaiser Family Foundation report has shown.

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In addition, only approximately 30% of Medicare Part D enrollees qualify for subsidies to lower their medication costs. To qualify for a low-income subsidy in 2016, a person’s annual income must be less than $17,820, and the person must have less than $13,640 in assets.

In this study, researchers examined time to start of treatment for 393 patients age 66 years and older with CML diagnosed between 2007 and 2011, and enrolled in Medicare Part D. Nearly one-third (32%) of patients had not started on 1 of the 3 TKIs approved as first-line treatment for CML within 6 months of diagnosis.

Patients with access to subsidies to cover the cost, started treatment 50 days sooner (58 days vs 108 days). Despite the gap in coverage, patients without subsidies eventually caught up, the researchers found. At 90 days from diagnosis, 48% of Medicare recipients without subsidies had started treatment vs 63% of those with subsidies; at 6 months, 64% without subsidies had started treatment vs 65% of patients with subsidies.

“We recognize that people have a high cost to even start therapy, and this study really demonstrates the difference between people with and without a subsidy initiating therapy,” said Stacie Dusetzina, PhD, a UNC Lineberger member and assistant professor in the UNC Eshelman School of Pharmacy and UNC Gillings School of Global Public Health.


1. UNC Lineberger Comprehensive Cancer Center. High up-front costs could delay access to life-saving blood cancer drugs for Medicare patients. EurekAlert! web site. Accessed October 3, 2016.