Medicare Beneficiaries Hit Hard by Prescription Costs


The inability to pay for essential medical care is not just a problem for people who lack health insurance. If you’re covered by insurance, whether through an employer or through Medicare, you can be overwhelmed by the costs of prescriptions and treatment.

The impact on cancer patients is especially burdensome, in part, because out-of-pocket (OOP) costs for specialty cancer medications are particularly high. This can lead to choices no one should have to make.

Staggering Out-of-Pocket Costs

According to a recent PAN Foundation brief, a review of 45 studies on financial hardship among cancer survivors showed that:

  • As many as 62% of survivors reported being in debt because of their treatment

  • Nearly 50% of survivors reported experiencing some form of financial distress

  • As many as 45% of survivors did not adhere to recommended prescription medication because of cost

If you have Medicare and are diagnosed with cancer, the financial impact can be catastrophic. Although Medicare beneficiaries can fund prescriptions by purchasing coverage or selecting a “Part D” drug plan, research demonstrates that OOP prescription costs are a serious problem for many Medicare beneficiaries.

Demographics data indicates that only 24% of the Medicare population is economically secure. For the majority who aren’t, health-related expenses consume a larger share of their resources. Research from the Kaiser Family Foundation shows that Medicare beneficiaries’ OOP spending on healthcare—as a percentage both of Social Security income and total income—is increasing. In fact, the report showed that as a share of per capita Social Security income, OOP healthcare spending will increase from 41% in 2013 to a projected 50% in 2030, a staggering and insupportable number.

Practical and Policy Solutions

What can be done to reduce this burden? At The Ghosh Center, we’re committed to working with each of our patients to obtain funding for OOP costs, but many people don’t have access to this assistance. The PAN Foundation, an organization that helps insured people cover prescription costs, advocates for thoughtful and sustainable policy-based solutions. The strategies they advocate include:

  • Putting a “hard cap” on OOP costs once beneficiaries reach Part D’s catastrophic threshold

  • Distributing OOP costs more evenly throughout the calendar year

  • Ensuring that health conditions have at least one effective drug that is not on a specialty tier

To follow along with PAN’s important work, check out their OOP Costs Among Medicare Beneficiaries brief or visit their website.To learn more about how The Ghosh Center helps patients pay for prescriptions, read a blog post about our financial assistance program and a recent PAN interview with Becki.