By Drs. Jalpa Doshi and John Lin
Imagine you are a 70-year old patient sitting in your oncologist’s office, processing a life-altering diagnosis. Your doctor prescribes a pill for your cancer that offers the best chance of survival. You arrive at the pharmacy, expecting a co-pay, but the bill looks more like a mortgage payment. “That will be $2,000 for the prescription,” the pharmacist says.
Now, imagine Medicare offers a payment plan to soften the blow. There’s just one catch: You need to know the program exists so you can sign up for it — which itself can be tricky. The Medicare Prescription Payment Plan (MPPP) may be the program’s best-kept secret, one that could help you or someone you love afford life-saving drugs. But most Medicare patients don’t know about it.
For millions of seniors, high costs for prescription drugs aren’t a hypothetical nightmare; they are a structural failure built into the Medicare Part D drug program. For years, the rules on coverage for the costliest drugs — for conditions like cancer, rheumatoid arthritis, and multiple sclerosis — have been an open scandal. Just a few years ago, many cancer patients had to pay $20,000 out-of-pocket annually for their medicines.
The Inflation Reduction Act (IRA) was designed to fix this. The law capped annual out-of-pocket drug costs at $2,000 in 2025 for all Medicare patients. This translates to an astounding 90% discount for many cancer patients. This annual maximum will slowly rise in future years.
On paper, this appears to be a long overdue fix. In reality, a critical flaw remains. While the total amount a patient owes in a year is lower, the timing of that expense can still be crippling. A patient needing an expensive cancer drug may owe their entire $2,000 annual maximum for a single prescription fill at the pharmacy.
Unless they pay upfront, patients must forgo treatment.
Our recent research reveals how the IRA’s annual out-of-pocket cap on its own falls short as an affordability fix. In 2024, as initial IRA protections phased in, fewer than half of Medicare patients filled their cancer prescription through their insurance.
Retailers like Best Buy and Walmart know how to make big-ticket items like televisions, laptops, or refrigerators affordable for consumers. They prominently advertise payment plans alongside any big purchase, allowing consumers to seamlessly enroll at the point-of-sale and spread the costs over longer periods.
Why hasn’t Medicare done the same?