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Medicare Drug Costs Up Despite Reduced 'Doughnut Hole' Skip to content

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Prices of Oral Anticancer Drugs Keep Rising for Medicare Patients

Out-of-pocket costs higher than in 2010, despite inflation and 'doughnut hole' savings

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En español | Despite the government's attempts to lower out-of-pocket drug costs for Medicare beneficiaries, a study shows that over the past decade, the costs for patients taking oral anticancer drugs continue to rise.

The study, published in JAMA, found that of 13 oral anticancer drugs available on the market in both 2010 and 2019, all but one cost more for patients under Medicare's Part D program. The average annual cost to a patient for the oral anticancer drugs increased from $8,794 in 2010 to an expected $10,470 in 2019, adjusted for inflation.

Today there are 54 oral anticancer medications available under Part D. In 2018, 48 of those cost more than $10,000 per month, though patients paid only 5 percent after reaching an annual $5,000 out-of-pocket threshold; for 21 drugs, the overall cost was more than $15,000 per month.


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The rise in out-of-pocket costs for the drugs comes in the wake of changes in the way costs are divided between patients and Medicare. Until the Affordable Care Act went into effect in 2010, patients were responsible for 100 percent of drug costs after reaching a threshold, with catastrophic coverage (for which the patient pays just 5 percent of costs) kicking in after a second threshold in spending. For 2018 those thresholds were $3,750 and $5,000.

But even though the “doughnut hole” rate for the patient has been reduced to 25 percent in recent years, the anticancer drugs’ prices have outstripped those savings to the consumer.

The study authors wrote that “efforts to reduce drug prices and limit beneficiary out-of-pocket spending are needed to improve access to high-cost drugs."

The study did not address the prices of anticancer drugs administered directly by doctors under Medicare's Part B.

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