Medicare Part B spent $20.9 billion on medications in 2013. Medicare Part B, which typically covers doctor’s visits and outpatient services, also covers some drugs that are administered by a physician, usually because they are injected or infused. Some new medications that have recently been covered have high price tags for Medicare and patients.
Medicare Part B drug expenditures grew by an average of 4.4 percent annually from 2007 through 2013, largely due to the cost of 83 new covered medications, according to an analysis by the Government Accountability Office. Some 61 percent of the new medications are biologics, which are drugs derived from living sources. These medications often require close supervision by a physician, personalized dosing and unique storage requirements, which adds to the expense.
The new medications are largely used to treat cancer, blood diseases or used for diagnostic imaging. Some of the drugs treat rare conditions, but the small number of people who require them tend to rack up large bills. Other drugs are widely used to treat conditions that are common among older patients. Three popular medications — Lucentis, Eylea and Prolia — were responsible for over half of the drug spending on new Part B drugs, GAO found. And nearly two-thirds of the new Part B drugs cost over $9,000 per beneficiary in 2013. Out-of-pocket costs for beneficiaries ranged from $1,900 to $107,000 per new drug.
Here’s a look at the new drugs that cost the most and what they are used for:
1. Lucentis. This drug was approved in 2006 and is used to treat age-related macular degeneration. It was the most expensive Medicare Part B drug in 2013, costing Medicare nearly $1.4 billion. The expense is largely due to high utilization, with 145,325 people requiring the drug. The cost per beneficiary was $9,423 in 2013.
2. Eylea. There were 109,527 retirees who used Eylea to treat age-related macular degeneration in 2013, which cost Medicare just over $1 billion. The cost per beneficiary is slightly more than Lucentis at $9,936. When Eylea was approved in 2011 it resulted in a surge in Medicare spending, GAO found.
3. Prolia. Prolia was used by 239,393 Medicare beneficiaries in 2013, at a cost of $665 million. Prolia expenditures increased 992 percent from 2011 to 2013 due to a 1,274 percent increase in utilization, according to GAO calculations. This osteoporosis drug was approved in 2010 and costs $2,776 per beneficiary.
4. Treanda. This cancer drug was used by only 15,288 Medicare beneficiaries in 2013, but it has the hefty price tag of $21,685 per person. Treanda, which was approved in 2008, is used to treat chronic lymphocytic leukemia and cost Medicare $332 million.
5. Lexiscan. This drug used for diagnostic imaging was approved in 2008 and cost Medicare $257 million in 2013, or $215 per beneficiary. Nearly 1.2 million Medicare beneficiaries used Lexiscan in 2013. Lexiscan is a chemical stress agent that can help test heart function in patients who cannot use a treadmill or stationary bike. It must be injected directly into the blood steam during a stress test to assess heart attack risk.
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The 5 Most Expensive Medications Medicare Covers originally appeared on usnews.com