Medicare and Cancer Treatment: Your Drugs May Soon Cost Less — What to Know About the Inflation Rebate Program

Thanks to the Medicare Prescription Drug Inflation Rebate Program, certain beneficiaries could save between $2 and $390 per average dose, depending on their specific insurance coverage, the Centers for Medicare & Medicaid Services (CMS) said.

The goal is to keep drug companies from increasing drug prices faster than the rate of inflationr. The rule requires the drug company to pay rebates to (or pay back) the Medicare program if they do.

It’s not uncommon for drug companies to quickly raise drug prices. Between 2019 and 2020, the cost of nearly half of all drugs covered under Part B outpaced inflation, according to a report from the Kaiser Family Foundation.

Americans spend more on prescription drugs than any advanced nation on Earth.

Now, under President Biden, Medicare will be able to drive prices down by negotiating with drug companies directly.

This will lower co-pays for seniors and costs to the federal government. pic.twitter.com/zMIvHjBggc

— The White House (@WhiteHouse) March 15, 2023

 

“The Biden-Harris Administration believes people with Medicare shouldn’t be on the hook when drug companies inexplicably jack up the prices of their drugs,” HHS Secretary Xavier Becerra stated as the news was revealed.

“With the inflation rebate program, we are fighting to ensure seniors can afford the treatments they need, taxpayers aren’t subsidizing drug company excess prices, and the Medicare program is strong for millions of beneficiaries now and in the future,” Becerra continued.

Which of the Drugs Help Treat Cancer?

Thirteen drugs included in the list can help cancer patients, and those are Akynzeo, Atgam, Aveed, Carnitor,  Elzonris, Folotyn, Leukine, Nipent, Padcev, Rybrevant, Sylvant, Tecartus, and Yescarta. Here’s what diseases these drugs are used to fight and what you should know about them:

• Akynzeo (netupitant and palonosetron): Used in combination with the medicine dexamethasone to prevent chemotherapy-induced nausea and vomiting.
• Atgam (antithymocyte globulin equine): Helps the body fight a type of white blood cell called a T-lymphocyte. Treats moderate to severe aplastic anemia in patients who are unable to get a bone marrow transplantation.
• Carnitor (levocarnitine): Used to prevent and treat carnitine (a chemical in the body) deficiency, as well as reduce fatigue in cancer patients. The National Cancer Institute says Carnitor is “used to treat patients who do not make enough carnitine and is being studied as a way to prevent tissue damage caused by chemotherapy.” It also called L-carnitine and levocarnitine.
• Elzonris (tagraxofusp-erzs): An anti-cancer medication that treats blastic plasmacytoid dendritic cell neoplasm, a type of blood cancer. It’s used in adults and pediatric patients ages two and older.
• Folotyn (pralatrexate solution for intravenous injection): Treats patients with relapsed or refractory peripheral T-cell lymphoma, a fast-growing form of non-Hodgkin lymphoma (cancer of the immune system) that recurred or did not get better with other anticancer therapy. The medicine prevents cells from using folic acid to make DNA.
• Leukine (sargramostim): A bone marrow stimulant that helps makes white blood cells after chemo or transplants. It’s an injectable medication that can decrease your risk of infection.
• Nipent (pentostatin for injection) : A chemotherapy drug to treat cancer, including hairy cell leukemia. It also treats other types of leukemia or lymphoma.
• Padcev (enfortumab vedotin): An antibody-drug conjugate that treats urothelial cancer. Studies have found Padcev effective for treating bladder and urinary tract cancer.
• Rybrevant (amivantamab): Treats locally advanced or metastatic non-small cell lung cancer.
• Sylvant (siltuximab):  Treats multicentric Castleman’s disease, a disease that increases the risk of developing cancer, including lymphoma.
• Tecartus (brexucabtagene autoleucel): A cell-based gene therapy used to treat mantle cell lymphoma or acute lymphoblastic leukemia. Tecartus is approved for treating adult patients (age 18 and older) with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL).
• Yescarta (axicabtagene ciloleucel): Used to treat large B-cell lymphoma that has returned.

Here is the full list of the 27 drugs subject to the inflation rebate program, click here

How Will The Rebate Program Affect What You Pay for the Drug With Medicare?

Cancer patients with Medicare will notice they may be paying less for medicine if they take any of the drugs listed above.

“Beginning April 1, 2023, people with Medicare may see lower out-of-pocket costs for certain Part B drugs and biologicals,” CMS said. “For these drugs and biologicals, the beneficiary coinsurance will be 20% of the inflation-adjusted payment amount, which will be less than what the beneficiary would pay in coinsurance otherwise.”

The beneficiary will ultimately pay less in coinsurance for specific Part B relatable drugs and healthcare providers will be subject to paying the difference between “the Medicare allowed amount and the adjusted beneficiary coinsurance, after applying the Part B deductible and prior to sequestration, if applicable.”

Does the Rebate Program Apply to You?

You may be see these lower drug costs if you have Traditional Medicare and/or Medicare Advantage.

Health insurance plan provider Anthem Blue Cross Blue Shield describes Traditional Medicare (which is also called Original Medicare) as including “Medicare Part A and Part B, which give you inpatient and outpatient coverage.”

“The difference with Medicare Advantage plans (Part C) is that they include Part A and Part B coverage, plus much more,” Anthem states on its website.

If you’re not sure what type of Medicare coverage you have, it’s always a good idea to reach out to your doctor or insurance company and they may be able to provide more detail on your specific plan.

Getting Help With the Bills & Unpaid Debt

While this is uplifting news, it may still leave some people with prescription costs that are difficult to pay. And it won’t make everyone’s medical bills decrease amid cancer treatment, which can be extremely costly.

Medical debt is something most cancer patients have no choice but to deal with. Luckily, SurvivorNet has compiled some helpful information on obtaining the resources you need to pay the bills.

Advocating Oncologists

It’s not unusual for doctors to call up your insurance company and advocate on your behalf. Many drug companies and clinical trials also provide patient assistance programs.

Paying for Cancer — Find Someone Who Will Advocate for You

Dr. Allyson Ocean, a medical oncologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, told SurvivorNet in an earlier interview she calls insurance companies almost every day, working to get her patients the treatment they need.

“My best advice to work around the system of whether or not drugs or tests can be covered for cancer is to make sure you have an advocate in your field working for you,” Dr. Ocean said. “The frustrating part for me is that sometimes we even have to educate the insurance companies and say, ‘There’s a reason why I want to use this medicine.’”

Connect With a Social Worker

Dr. Nina Shah, a hematologist at the University of California San Francisco, previously told SurvivorNet that for patients with high costs associated with their cancer treatment, it can be beneficial for them to speak with social workers.

How to Get Help With the Cancer Bills

The social workers at your local cancer care clinic can assist you with the available options.

“The best way to look at this and find the resources that are available is to speak with the social worker associated with (your cancer center),” Dr. Shah said. “Because that person usually knows what resources are available and what you can do to access them.”

Patient Assistance Programs

Additionally, most big drug companies have assistance programs offered by pharmaceutical companies that can patients who are unable to afford the full cost.

It can be difficult navigating approval criteria, so it can be helpful to ask any questions you might have.

Get in Touch With Foundations Set Up to Help With Bills

Lastly, a number of nonprofit and advocacy organizations exist that offer programs to financially support those unable to front the costs associated with their care.

One option is the Lazarex Cancer Foundation. This foundation reimburses patients for the funds associated with clinical trial participation. Other organizations including the American Cancer Society (ACS) and the Cancer Support Community may help patients secure lodging and travel for their care.

While it may initially seem impossible, just remember that paying off your medical bills is doable, and most importantly, it can be done with some assistance.

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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