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New CMS Data Release Shows the Growth in Costs from Drugs Associated with Hematologic Conditions

In December 2015, the Centers for Medicare and Medicaid Services (CMS) released yet another data set on their website, this time detailing the costs associated with various prescription drugs in the Medicare program. Data was presented for the cost of drugs for 2010 and 2014 and both those with high overall spending and large increases in expenditure were included for analysis. Although the data provided is not comprehensive, it clearly demonstrates the enormity of costs associated with care for hematologic conditions, despite the relatively small number of specialists in that area. These large and increasing costs reflect both the increasing numbers of drug treatments and in some cases increases in cost for the individual drug. The data includes both the cost of drugs for those administered by physicians under Medicare Part B and those self-administered oral drugs under Medicare Part D.

The first year of data, 2010, shows twelve drugs with some tie to hematology care found among the costliest drugs in the Medicare system. The most expensive, rituximab, a treatment for a number of different blood cancers as well as other diseases not treated by hematologists, cost the Medicare system and patients combined more than $1.2 billion despite only 63,000 Medicare patients (of more than 40 million). In contrast, more than ten times as many beneficiaries received B-12 injections in 2010, but the cost was just over a million dollars.

In 2014, the cost of rituximab grew to $1.5 billion in the Medicare population, but it was no longer the most expensive drug associated with hematology. By 2014, lenalidomide, used for multiple myeloma and mantle cell lymphoma, cost Medicare and its beneficiaries nearly $1.7 billion. The number of patients receiving this drug was even smaller, at just over 27,000. Because lenalidomide is an oral drug, many patients are responsible for large portions of the cost because of the benefit structure of Medicare Part D plans that require cost sharing at various portions and does not have an upper limit on spending. Despite these extraordinarily high costs, lenalidomide was only the 10th most costly drug in the Medicare system in 2014. The most expensive by far was sofosbuvir, the newly released treatment for hepatitis C. Other drugs which outpaced lenalidomide treated far more common conditions such as diabetes and asthma.

The cost of drugs is even more dramatic when compared to the costs of other parts of the healthcare system. The total expenditures by Medicare for physicians specializing in hematology and oncology (they are combined in Medicare data) is estimated to be $1.8 billion. This includes all payments for office and hospital visits as well as the clinical staff work associated with infusing drugs. While this does not include a portion of the payment for hospital-employed physicians, it covers all of the work provided by physicians.

The high cost of drugs remains a major topic in political debate and ASH continues to be committed to ensuring that patients have access to safe and effective drugs that are appropriately priced.