{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:09:27Z","timestamp":1790842167543,"version":"4.1.0"},"reference-count":25,"publisher":"American Society of Clinical Oncology (ASCO)","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"abstract":"<jats:sec>\n            <jats:title>PURPOSE<\/jats:title>\n            <jats:p>Medicare Part D beneficiaries who do not qualify for low-income subsidies face high out-of-pocket (OOP) costs for brand-name specialty oral anticancer medications (SOAMs). We calculated how OOP costs for such SOAMs might evolve on the basis of the Inflation Reduction Act\u2019s (IRA) Part D benefit changes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS<\/jats:title>\n            <jats:p>We calculated OOP costs for 10 commonly used brand-name SOAMs across various cancers under four Part D benefit scenarios: (1) 2023: before IRA implementation (pre-IRA), (2) 2024: an annual OOP maximum set at the catastrophic threshold during initial IRA implementation (mid-IRA), (3) 2025: an annual OOP maximum set at $2,000 in US dollars (USD) after final IRA implementation (post-IRA, default), and (4) 2025: $2,000 USD annual OOP maximum and voluntary enrollment in the Medicare Prescription Payment Plan (MPPP) to smooth OOP costs via monthly payments (post-IRA, opt-in MPPP).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>In 2023 (pre-IRA), annual OOP costs for SOAMs ranged from $11,143 USD to $20,592 USD. In 2024 (mid-IRA) and 2025 (post-IRA), beneficiaries would only pay the new OOP maximums of $3,333 USD and $2,000 USD, respectively, regardless of SOAM prescribed or treatment duration. In 2025, the $2,000 USD OOP amount would be entirely frontloaded in January unless beneficiaries enroll in the MPPP, which could lower their OOP costs to just $167 USD for January and each calendar month thereafter, regardless of SOAM prescribed or treatment duration.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION<\/jats:title>\n            <jats:p>Although the annual OOP maximum enacted by the IRA will decrease OOP costs significantly for Medicare beneficiaries treated with brand-name SOAMs beginning 2025, enrollment in the MPPP is critical to avoid patients owing the entire $2,000 USD in January alone. Oncology providers have a critical role to play in ensuring beneficiaries are aware of the option to smooth their OOP costs via MPPP enrollment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1200\/op-24-00937","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T19:59:09Z","timestamp":1745611149000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":4,"title":["Reducing Medicare Part D Out-of-Pocket Costs for Specialty Oral Anticancer Drugs Under the Inflation Reduction Act: Highlighting the Benefits of Enrolling in the Medicare Prescription Payment Plan"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3263-4337","authenticated-orcid":false,"given":"Jalpa A.","family":"Doshi","sequence":"first","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengxiang","family":"Li","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1356-3764","authenticated-orcid":false,"given":"Shravan","family":"Asthana","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2490-4453","authenticated-orcid":false,"given":"John K.","family":"Lin","sequence":"additional","affiliation":[{"name":"University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"e_1_3_6_2_2","volume-title":"Cancer in Medicare: An American Cancer Society Cancer Action Network Chartbook","author":"American Cancer Society","year":"2024","unstructured":"American Cancer Society: Cancer in Medicare: An American Cancer Society Cancer Action Network Chartbook. Atlanta, GA, American Cancer Society Cancer Action Network, 2024"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.13164"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2018.04.44"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13624"},{"key":"e_1_3_6_6_2","first-page":"S39","article-title":"Reducing out-of-pocket cost barriers to specialty drug use under Medicare Part D: Addressing the problem of \u201ctoo much too soon.\u201d","volume":"23","author":"Doshi JA","year":"2017","unstructured":"Doshi JA, Li P, Pettit AR, et al: Reducing out-of-pocket cost barriers to specialty drug use under Medicare Part D: Addressing the problem of \u201ctoo much too soon.\u201d Am J Manag Care 23:S39-S45, 2017","journal-title":"Am J Manag Care"},{"key":"e_1_3_6_7_2","volume-title":"The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019","author":"Cubanski J","year":"2019","unstructured":"Cubanski J, Koma W, Neuman T: The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019. San Francisco, CA, KFF, 2019"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.74.5091"},{"key":"e_1_3_6_9_2","first-page":"s78","article-title":"High cost sharing and specialty drug initiation under Medicare Part D: A case study in patients with newly diagnosed chronic myeloid leukemia","volume":"22","author":"Doshi JA","year":"2016","unstructured":"Doshi JA, Li P, Huo H, et al: High cost sharing and specialty drug initiation under Medicare Part D: A case study in patients with newly diagnosed chronic myeloid leukemia. Am J Manag Care 22:s78-s86, 2016","journal-title":"Am J Manag Care"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1262"},{"key":"e_1_3_6_11_2","volume-title":"Monthly Out-of-Pocket Cost Caps Are Needed Under Medicare Part D to Improve Access to Specialty Drugs","author":"Doshi J","year":"2020","unstructured":"Doshi J, Li P, Ladage VP: Monthly Out-of-Pocket Cost Caps Are Needed Under Medicare Part D to Improve Access to Specialty Drugs. Washington, DC, PAN Foundation, 2020"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01742"},{"key":"e_1_3_6_13_2","first-page":"669","article-title":"Out-of-pocket costs and oral cancer medication discontinuation in the elderly","volume":"20","author":"Kaisaeng N","year":"2014","unstructured":"Kaisaeng N, Harpe SE, Carroll NV: Out-of-pocket costs and oral cancer medication discontinuation in the elderly. J Manag Care Spec Pharm 20:669-675, 2014","journal-title":"J Manag Care Spec Pharm"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2022.28.8.831"},{"key":"e_1_3_6_15_2","volume-title":"Text - H.R.5376 - 117th Congress (2021-2022): Inflation Reduction Act of 2022","author":"US Congress","year":"2022","unstructured":"US Congress: Text - H.R.5376 - 117th Congress (2021-2022): Inflation Reduction Act of 2022. Congress.gov, Library of Congress, 2022. https:\/\/www.congress.gov\/bill\/117th-congress\/house-bill\/5376\/text"},{"key":"e_1_3_6_16_2","volume-title":"Millions of People With Medicare Will Benefit From the New Out-of-Pocket Drug Spending Cap Over Time","author":"Cubanski J","year":"2024","unstructured":"Cubanski J, Neuman T, Damico A: Millions of People With Medicare Will Benefit From the New Out-of-Pocket Drug Spending Cap Over Time. San Francisco, CA, KFF, 2024"},{"key":"e_1_3_6_17_2","volume-title":"Medicare Prescription Payment Plan","author":"Centers for Medicare & Medicaid Services","year":"2024","unstructured":"Centers for Medicare & Medicaid Services: Medicare Prescription Payment Plan. CMS, 2024. https:\/\/www.cms.gov\/inflation-reduction-act-and-medicare\/part-d-improvements\/medicare-prescription-payment-plan"},{"key":"e_1_3_6_18_2","volume-title":"Smoothing Medicare Part D out-of-pocket costs under the Inflation Reduction Act","author":"Doshi JA","year":"2023","unstructured":"Doshi JA, Niles A: Smoothing Medicare Part D out-of-pocket costs under the Inflation Reduction Act. Health Affairs Forefront, February 3, 2023. https:\/\/www.healthaffairs.org\/content\/forefront\/smoothing-part-d-out-pocket-costs-under-inflation-reduction-act"},{"key":"e_1_3_6_19_2","volume-title":"Part D Improvements","author":"Centers for Medicare & Medicaid Services","year":"2025","unstructured":"Centers for Medicare & Medicaid Services: Part D Improvements. CMS, 2025. https:\/\/www.cms.gov\/inflation-reduction-act-and-medicare\/part-d-improvements"},{"key":"e_1_3_6_20_2","volume-title":"Micromedex RED BOOK","unstructured":"Micromedex RED BOOK. https:\/\/www.merative.com\/documents\/micromedex-red-book"},{"key":"e_1_3_6_21_2","first-page":"279","article-title":"Medicare Part D low-income subsidies expanded in January 2024, but more needs to be done to ensure that eligible beneficiaries enroll","volume":"30","author":"Loh FE","year":"2024","unstructured":"Loh FE, Stuart BC, Hunt RJ, et al: Medicare Part D low-income subsidies expanded in January 2024, but more needs to be done to ensure that eligible beneficiaries enroll. J Manag Care Spec Pharm 30:279-289, 2024","journal-title":"J Manag Care Spec Pharm"},{"key":"e_1_3_6_22_2","volume-title":"Medicare Prescription Payment Plan Final Part One Guidance","author":"Seshamani M","year":"2024","unstructured":"Seshamani M: Medicare Prescription Payment Plan Final Part One Guidance. CMS, 2024. https:\/\/www.cms.gov\/files\/document\/medicare-prescription-payment-plan-final-part-one-guidance.pdf"},{"key":"e_1_3_6_23_2","volume-title":"Medicare Prescription Payment Plan Final Part Two Guidance","author":"Seshamani M","year":"2024","unstructured":"Seshamani M: Medicare Prescription Payment Plan Final Part Two Guidance. CMS, 2024. https:\/\/www.cms.gov\/files\/document\/medicare-prescription-payment-plan-final-part-two-guidance.pdf"},{"key":"e_1_3_6_24_2","volume-title":"What\u2019s the Medicare Prescription Payment Plan?","author":"Centers for Medicare & Medicaid Services","year":"2024","unstructured":"Centers for Medicare & Medicaid Services: What\u2019s the Medicare Prescription Payment Plan? CMS, 2024. https:\/\/www.medicare.gov\/prescription-payment-plan"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01799"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2021.27.10.1457"}],"container-title":["JCO Oncology Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/OP-24-00937","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T19:59:14Z","timestamp":1745611154000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/OP-24-00937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":25,"alternative-id":["10.1200\/OP-24-00937"],"URL":"https:\/\/doi.org\/10.1200\/op-24-00937","relation":{},"ISSN":["2688-1527","2688-1535"],"issn-type":[{"value":"2688-1527","type":"print"},{"value":"2688-1535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]},"assertion":[{"value":"2024-11-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-12","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"OP-24-00937"}}