Report Finds Steep Access Barriers and High Costs for Medicare Drug Patients
What happened
A report released by ICER and West Health, utilizing information from IQVIA, found that the median price for drugs launched in 2025 was $250,000. The analysis of over 200 novel drugs showed that only about one-third of outpatient prescriptions were filled within 30 days of being written. Medicare patients experienced the steepest access barriers and paid two to five times more out-of-pocket compared to those with commercial insurance.
From bioxconomy.com
Why it matters
The findings highlight significant disparities in drug affordability and access within the Medicare program. The report also noted that financial assistance programs designed to mitigate high list prices are facing criticism from payers. This points to systemic issues regarding drug pricing and patient costs.
From bioxconomy.com
Who's involved
- IQVIAProvided longitudinal real-world information for the report.
- ICERCollaborated with West Health to develop and publish the report.
- West HealthPartnered with ICER to develop the report on healthcare affordability.
- MedicareThe US federal health insurance program whose access barriers were analyzed.
Who could feel it
Possible knock-on effectsThese are possibilities Brind reasoned out, not predictions, and not advice. Most are not stated in any report.
- MedicareSpeculative
Medicare might face increased regulatory pressure due to the highlighted access barriers and high out-of-pocket costs.
- Eli Lilly and CompanySpeculative
Eli Lilly and Company could face pressure on market pricing due to the report's findings on high drug costs.
- HumanaSpeculative
Humana could experience increased operational risk due to high out-of-pocket costs and access barriers for patients.
Keep exploring
The entities involved
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IQVIA
company that provides information, services and technology for the healthcare industry
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ICER
Nothing else this week.
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West Health
healthcare organization in San Diego, United States
Nothing else this week.
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Medicare
US federal health insurance