TABLE 4.
Medicare Beneficiary Out-of-Pocket Costs for Each of the Drugs Facing Price Negotiations (2020)
| Drug name (Brand) | Mean patient out-of-pocket spending among beneficiaries with low-income subsidies, mean (median) | Mean patient out-of-pocket spending among beneficiaries without low-income subsidies, mean (median) | Beneficiaries who reached $2,000 in annual Part D out-ofpocket costs, % | ||
|---|---|---|---|---|---|
| Per claim | Per year (total Part D)a | Per claim | Per year (total Part D)a | Non-LIS | |
| Apixaban (Eliquis) | $5 (0) | $119 (40) | $107 (57) | $1,433 (1,187) | 22 |
| Rivaroxaban (Xarelto) | $5 (0) | $114 (49) | $116 (68) | $1,426 (1,190) | 22 |
| Sitagliptin phosphate (Januvia) | $4 (2) | $112 (69) | $104 (60) | $1,391 (1,153) | 25 |
| Insulin aspart (Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill)b | $4 (0) | $107 (46) | $111 (72) | $1,859 (1,672) | 42 |
| Ibrutinib (Imbruvica) | $22 (0) | $242 (9) | $649 (649) | $6,449 (6,867) | 76 |
| Empagliflozin (Jardiance) | $5 (4) | $126 (86) | $109 (63) | $1,619 (1,386) | 36 |
| Etanercept (Enbrel) | $3 (0) | $60 (29) | $241 (60) | $2,224 (1,039) | 35 |
| Sacubitril and valsartan (Entresto) | $6 (4) | $142 (90) | $109 (60) | $1,616 (1,423) | 34 |
| Ustekinumab (Stelara) | $4 (0) | $42 (17) | $552 (88) | $2,868 (1,160) | 38 |
| Dapagliflozin (Farxiga) | $4 (4) | $124 (88) | $110 (70) | $1,631 (1,390) | 35 |
| All 10 drugs | $4 (0) | $115 (59) | $114 (60) | $1,475 (1,204) | 22 |
| Nonnegotiated drugs | $1 (0) | $59 (28) | $16 (5) | $658 (360) | 25 |
aRepresents total annual Part D out-of-pocket spending on any drug claims for beneficiaries using each negotiated drug.
bAffected by $35 insulin cap.
LIS = low-income subsidy.