[Ip-health] Harvoni & Sovaldi, Xtandi in Top 20 Costliest Medicare Drugs

Zack Struver zack.struver at keionline.org
Mon Jul 25 16:39:36 PDT 2016


​The Associated Press recently released a chart from the Centers for
Medicare and Medicaid Services' Office of the Actuary that outlines
spending for the top 20 costliest drugs to Medicare in 2015 after reaching
Medicare's catastrophic spending threshold:
(Also available as image in link above)

As the AP explains, catastrophic spending begins after an individual
beneficiary meets a specific threshold ($4,850 for 2015). During
catastrophic spending, "The beneficiary pays only 5 percent, while their
insurer pays 15 percent, and taxpayers cover 80 percent." The AP further
noted that "Catastrophic spending is a large and growing share of total
costs, threatening to make Medicare's popular prescription plan financially
unsustainable." The CMS data shows the combined spending after catastrophic
coverage, including beneficiary, insurer, and taxpayer contributions.

The CMS data revealed the following:

*Total spending for the top 20 Medicare drugs reached over $20 billion last

*Total combined spending on Harvoni and Sovaldi reached $7.5 billion, 37.4%
of the total top 20 spend.

*Medicare spent between 4.4 and 16.3 times more on Harvoni and Sovaldi
combined compared to each other drug in the top 20.

*Spending for Xtandi increased from $447 million in 2014 to $633 million in
2015, an increase of 41.6%.

*Drugs with a primary indication for cancer accounted for 5 of the top 20
drugs and $4.4 billion in spending (22.1% of total spending in the top 20).

*Patients paid an estimated $1 billion in coinsurance for the top 20 drugs,
on top of insurance premiums and other health care costs.​

Zack Struver, Communications and Research Associate
Knowledge Ecology International
zack.struver at keionline.org
Twitter: @zstruver <https://twitter.com/zstruver>
Office: +1 (202) 332-2670 Cell: +1 (914) 582-1428

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