ADVI SAVES analyzed Part D Event (PDE) data from 2017 to 2021 and found that 3% of the Part D population has OOP expenses of $2,000 or more. This proportion has been remarkably stable over the past five years despite changing drug prices, new medications, and the COVID-19 impact on healthcare utilization in 2020.
Table 1 – Historical Proportion of Part D Beneficiaries With >=$2000 Patient Spending in a Year
Table 2 below shows some of the patient demographics of the total Part D population compared to the non-LIS patients whose OOP costs exceed $2,000 in 2021. Part D beneficiaries who exceed $2,000 in OOP costs are disproportionately white and enrolled in PDP plans.
Table 2 – Demographic Breakdown of Beneficiaries With >=$2000 Patient Spending in 2021
** PDP = Stand-alone Prescription Drug Plan; MCO = Manage Care Organization other than PPO
ADVI also analyzed the timing of when beneficiaries reached the $2,000 OOP amount during the plan year. The timing of beneficiaries meeting the threshold impacts the amount of prescription drug costs that plans, Medicare, and manufacturers will need to cover under the new benefit design. Figure 1 below shows the breakdown of non-LIS patients reaching the OOP threshold by month. In 2021, nearly 50% of patients did not meet the $2,000 threshold until August.
Figure 1 – Cumulative Percent of Part D Non-LIS Beneficiaries That Reach $2,000 Threshold in 2021
ADVI SAVES continues to evaluate the implications of the IRA for our clients. Our access to 2021- and 2022-Part B and D Medicare claims enables us to determine the list of potential drugs subject to negotiation as well as analyze patient populations to create manufacturer liability models.
If you have questions or are interested in learning more about this data, please contact Caitlin Sheetz (Caitlin.firstname.lastname@example.org) or your ADVI account manager.