A new brief published by the Kaiser Family Foundation analyzes cost-sharing liability for Part B drugs in traditional Medicare and cost-sharing requirements in Medicare Advantage (MA) plans. Here are the key findings.

The analysis is based on 2019 Medicare claims data for separately payable (non-packaged) Part B drugs from a 20 percent sample of Medicare beneficiaries, removing drugs taken by fewer than 11 beneficiaries in the sample. MA cost-sharing amounts and plan designs are based on the Centers for Medicare & Medicaid Services (CMS) Medicare Plan Finder data for 2022 and 2022 PBP Benefits file. Enrollment numbers are from the CMS January 2022 enrollment files.

Researchers found:

  • One in four traditional Medicare beneficiaries faced cost-sharing liability of at least $1,000 and nearly one in five faced cost-sharing liability of at least $2,000 in 2019.
  • For more than half of all Part B drugs included in the analysis, average annual cost-sharing liability was $1,000 or more in 2019.
  • MA enrollees typically face 20 percent coinsurance for Part B drugs but can be exposed to higher cost-sharing requirements for these drugs when administered by an out-of-network provider.

Unlike traditional Medicare, MA plans have an out-of-pocket limit, but analysts said MA enrollees could still have significant costs for some of the higher-priced Part B drugs, especially if an out-of-network provider prescribes the drugs. In conclusion, researchers said allowing Medicare to negotiate drug prices could help address the spending burden for Medicare beneficiaries if they need high-cost drugs.