When patients face higher out-of-pocket costs, they are less likely to fill their prescriptions. This trend is consistent across all brands, therapeutic classes, and payer channels. If a patient does not fill a payer-approved prescription, it is considered abandoned. This behavior influences insurers' benefit designs, access contracts, and demand capture strategies, and is a key consideration for policymakers aiming to assist patients.
As patients' out-of-pocket costs rise, their likelihood of continuing therapy in the first year (i.e., adherence) declines. This relationship holds across different diseases, products, and patient types. Factors such as competing therapies, patient demographics, support programs, and annual out-of-pocket caps, like Medicare Part D’s $2,000 max, all contribute to shaping patient adherence.
Persistence measures how long a patient continues a prescription, while “One and Done” describes those who fill only once and do not return. This can stem from price concerns, side effects, other health issues, dosing, effectiveness, demographics, or insurance coverage. Securing the initial fill is costly, but ensuring patients continue therapy is essential for better outcomes and accurate forecasting. If patients stop treatment early, they miss the potential benefits of therapy.
Big changes are coming to Medicare Part D. Following the removal of catastrophic phase cost-sharing in 2024, a new $2,000 annual out-of-pocket cap takes effect in 2025. This major policy shift has the potential to reshape patient behavior as the reduced financial burden are expected to reduce prescription abandonment, improve treatment initiation rates, and enhance long-term adherence.
How is the $2,000 Medicare Part D cap that began this year reshaping speciality treatment access? Dive deeper into its impact on oncology with trends from recent years as changes from the Inflation Reduction Act took effect. Patients are seeing improved access, but the ripple effects matter for other key stakeholders, too.