Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania.
Urol Pract. 2023 Sep;10(5):476-483. doi: 10.1097/UPJ.0000000000000425. Epub 2023 Jul 3.
Combination systemic therapy for advanced prostate cancer has reduced mortality, but high out-of-pocket costs impose financial barriers for patients. The Inflation Reduction Act's $2,000 out-of-pocket spending cap for Medicare's prescription drug benefit (Part D) can potentially lower out-of-pocket spending for beneficiaries starting in 2025. This study aims to compare out-of-pocket spending for commonly prescribed regimens for advanced prostate cancer before and after implementation of the Inflation Reduction Act.
Medication regimens constructed to treat metastatic, hormone-sensitive prostate cancer consisted of baseline androgen deprivation therapy with traditional chemotherapy, androgen receptor inhibitors, and androgen biosynthesis inhibitors. Using 2023 Medicare Part B prices and the Medicare Part D plan finder, we estimated annual out-of-pocket costs under current law and under the Inflation Reduction Act's redesigned standard Part D benefit.
Under current law, out-of-pocket costs for Part D drugs ranged from $464 to $11,336 per year. Under the Inflation Reduction Act, annual out-of-pocket costs for 2 regimens remained unchanged: androgen deprivation therapy with docetaxel and androgen deprivation therapy with abiraterone and prednisone. However, out-of-pocket costs for regimens using branded novel hormonal therapy were significantly lower under the 2025 law with potential savings estimated to be $9,336 (79.2%) for apalutamide, $9,036 (78.7%) for enzalutamide, and $8,480 (76.5%) for docetaxel and darolutamide.
The $2,000 spending cap introduced by the Inflation Reduction Act may significantly decrease out-of-pocket costs and reduce financial toxicity associated with advanced prostate cancer treatment, impacting an estimated 25,000 Medicare beneficiaries.
晚期前列腺癌的联合系统治疗降低了死亡率，但高昂的自付费用给患者带来了经济障碍。《降低通胀法案》为医疗保险处方药福利（Part D）设定的 2000 美元自付支出上限，可能会降低 2025 年开始受益人的自付支出。本研究旨在比较《降低通胀法案》实施前后，晚期前列腺癌常用治疗方案的自付费用。
构建用于治疗转移性、激素敏感型前列腺癌的治疗方案包括基线雄激素剥夺治疗联合传统化疗、雄激素受体抑制剂和雄激素生物合成抑制剂。使用 2023 年医疗保险 B 部分价格和医疗保险 D 部分计划查找器，我们根据现行法律和《降低通胀法案》重新设计的标准医疗保险 D 部分福利，估算每年的自付费用。
根据现行法律，医疗保险 D 部分药物的自付费用每年为 464 美元至 11336 美元。根据《降低通胀法案》，两种方案的年度自付费用保持不变：多西他赛联合雄激素剥夺治疗和阿比特龙联合泼尼松联合雄激素剥夺治疗。然而，在 2025 年的法律下，使用品牌新型激素治疗的方案的自付费用显著降低，估计节省金额分别为阿帕鲁胺 9336 美元（79.2%）、恩扎卢胺 9036 美元（78.7%）和多西他赛和达罗他胺 8480 美元（76.5%）。
《降低通胀法案》引入的 2000 美元支出上限可能会显著降低自付费用，并降低与晚期前列腺癌治疗相关的经济毒性，预计将影响约 25000 名医疗保险受益人。
