Rising Medicare Part D Premiums: A Concern for Oncology Patients

Scott Soefje,PharmD,MBA,BCOP,FCCP,FHOPA,recently discussed the potential impact of rising Medicare part D premiums with Pharmacy Times®. He emphasized the uncertainty surrounding these changes and how they might affect patients and health systems. While the full extent of the impact is still unknown, research on medication adherence shows even small increases in copays – sometimes just $5 or $6 – can cause patients to stop taking their medications.

Soefje explained that oncology pharmacists could face tough choices about continuing expensive medications or switching patients to perhaps less effective alternatives. He anticipates more patients will need assistance programs, which means pharmacists will likely spend more time navigating manufacturer support processes, especially in health systems that don’t already have systems in place to help. The main worry is finding ways to help patients manage these financial burdens without sacrificing their care.

Pharmacy Times: With the base Part D subsidy dropping from $15 to $10 in 2026, how are oncology pharmacies prioritizing outreach for patients at highest risk of cost-related non-adherence?

Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA: First, we need to acknowledge that a lot of this is still speculation. We don’t know exactly how these changes will play out. But if the subsidy dose decrease, we certainly know from adherence studies that any increase in copays or out-of-pocket costs leads to patients stopping their medications. The data is pretty clear on this, and sometimes even a $5 or $6 increase can be enough to make someone stop filling their prescription.

Our biggest concern is for patients who are already on therapy, doing well, and then suddenly receive a higher bill. How will we address that situation?

Oncology pharmacists will be in difficult positions. Will we keep patients on their current, expensive medication, or switch them to something cheaper that might be less effective? Do we risk changing a treatment that’s working to one that might not be as good?