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NEW TWEETORIAL : ICYMI our new @NEJM perspective on #PartD came out this weekend. Don't worry - I'll catch you up! If you don't like GIFS (LOL, who doesn't like GIFS!?!) then you can just read it here: https://www.nejm.org/doi/full/10.1056/NEJMp2027580
This paper is about some of my favorite topics. #PartD #Medicare #Gleevec. @TIME basically named Gleevec the person of the year and it is a drug. It is the BEST. DRUG. EVER. Really works. But, is really expensive.
So, everyone was looking forward to generic entry. People who need Gleevec need to take it for the rest of their lives so it can be a huge financial burden! Generic arrives on #PartD formularies in early 2016! HURRAY!!! 
But, bad news. The point-of-sale price didn't drop for the first few years that the generic was available. This is the amount on which we calculate what patients will pay. ** Note, the drop starting in 2018 is likely due to the 4th generic manufacturer entering the market!**
In fact, patients actually spent MORE on the generic in #PartD for the first 3 full years that the generic was available.
We found that annual out-of-pocket spending on generic imatinib in 2020 was only 24% lower than estimated spending on Gleevec just before generic entry ($6,352 vs. $8,322), despite the roughly 80% difference in list price.
Even worse, patients didn't have a choice in a lot of plans as they shifted to covering only the generic. We have talked about why this happens before in the @Health_Affairs paper: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05476
@medicarepayment has warned us about this problem for a long time. We need to fix it. @ChuckGrassley @RonWyden @SenFinance @SpeakerPelosi all have draft legislation from 2019 that FIXES this issue for #PartD, along with other sensible reforms. Let's fix it in 2021.
Thank you to @commonwealthfnd @LLSusa and @Arnold_Ventures for funding, and to my awesome collaborators @HMSHCP Haiden Huskamp and @NancyKeatingMD & @UNCPharmacy @Benyam_Muluneh!
Also, h/t to @gary_lyman for flagging this excellent and related @fredhutch piece summarizing the patient experience on anticancer drugs. High out-of-pocket costs for Medicare beneficiaries (even for generic anticancer drugs) is a problem: https://www.fredhutch.org/en/news/center-news/2020/12/new-cancer-drugs-financial-toxicity-TKI.html
