> ## Content Index > Fetch the complete content index at: https://www.smartseniordaily.com/llms.txt > Use this file to discover other available public pages before exploring further. # Cancer Rx affordability still falls short for seniors - URL: https://www.smartseniordaily.com/cancer-rx-affordability-still-falls-short-for-seniors/ - Published: 2025-12-31T14:30:27.000Z - Updated: 2025-12-31T14:30:27.000Z - Description: A new JAMA study shows Medicare’s drug cap helps — but not enough - Author: Gary P Guthrie - Tags: Medicare --- If you've been caught up in the current news cycle, you've no doubt heard the word “affordability” being volleyballed around on Capitol Hill. Prescription drugs certainly fit into that category and – at least on paper – Medicare’s long-awaited cap on out-of-pocket [drug costs](https://www.smartseniordaily.com/medicare-drug-costs-could-drop-sharply-in-2026/) looks like a win. However... In real life, many seniors with cancer are still walking away from the pharmacy counter. New [research published in **JAMA**](https://jamanetwork.com/journals/jama/article-abstract/2843259?ref=smartseniordaily.com) finds that even after Medicare Part D cost-sharing changes took effect in 2024, too many beneficiaries can’t afford to start lifesaving oral cancer medications. [Medicare Drug Costs Could Drop Sharply in 2026Eliquis, Januvia, and Jardiance included in the savings plan![](https://storage.ghost.io/c/d9/1a/d91a71e8-ed81-4ec8-8028-ec14ba129b35/content/images/icon/SSD-FavIcon1-63.png)Smart Senior DailyGary P Guthrie![](https://storage.ghost.io/c/d9/1a/d91a71e8-ed81-4ec8-8028-ec14ba129b35/content/images/thumbnail/DRUG-PRICES-2026-1.png)](https://www.smartseniordaily.com/medicare-drug-costs-could-drop-sharply-in-2026/) ## What changed — and what didn’t Under the Inflation Reduction Act, Medicare eliminated the 5% coinsurance requirement in the catastrophic phase of Part D for beneficiaries without low-income subsidies. That change effectively capped annual out-of-pocket prescription drug costs at about **$3,250** for people using specialty oral anticancer medications. The expectation was straightforward: lower the cap, and more patients would fill their prescriptions. The reality turned out to be messier. Researchers analyzed prescription fill rates before and after the policy change and found that **average upfront costs for a new oral cancer drug still exceeded $2,000** for many Medicare beneficiaries. While prescription approvals increased, **fewer than half of eligible patients filled their insurer-approved prescriptions within 60 days**. In short, cost relief spread over the year didn’t solve the immediate “sticker shock” patients face at the pharmacy. As the study notes, Medicare beneficiaries with cancer have long delayed or skipped treatment because of high out-of-pocket drug costs — and the cap hasn’t fully fixed that problem. > The full study, *“Specialty Oral Anticancer Prescription Fill Rates After Medicare Part D Cost-Sharing Changes in 2024,”* is available [here](https://jamanetwork.com/journals/jama/article-abstract/2843259?ref=smartseniordaily.com). ## The upfront cost problem While total annual spending may now be lower, the first pharmacy bill often arrives before the cap provides meaningful relief. For seniors living on fixed incomes, that initial charge can delay — or completely derail — treatment. The findings reinforce a long-standing issue in Medicare drug coverage: lowering annual exposure does not necessarily address affordability at the moment treatment begins. ## A little-known option that could help One potential workaround already exists. The **Medicare Prescription Payment Plan** allows beneficiaries to spread prescription drug costs across monthly payments instead of paying large sums upfront. That option could significantly ease the burden for patients starting expensive cancer therapies. But awareness remains low, and timing matters. The earlier a beneficiary enrolls, the more months they have to spread costs. **January 2026 represents a key window** for seniors who expect high prescription expenses in the coming year. [How to Appeal a Denied Social Security or Medicare Claim — Without Losing Your MindBe sure to download our free appeal checklist and sample letter.![](https://storage.ghost.io/c/d9/1a/d91a71e8-ed81-4ec8-8028-ec14ba129b35/content/images/icon/SSD-FavIcon1-64.png)Smart Senior DailySmart Senior Daily Staff![](https://storage.ghost.io/c/d9/1a/d91a71e8-ed81-4ec8-8028-ec14ba129b35/content/images/thumbnail/MedicareClaim-Denied1.png)](https://www.smartseniordaily.com/how-to-appeal-a-denied-social-security-or-medicare-claim-without-losing-your-mind/) ## Why it matters Cancer treatment decisions are rarely optional. When patients walk away from approved prescriptions because of cost, even well-intended policy reforms fall short. This research highlights a persistent gap between Medicare’s affordability goals and the real-world experience of seniors at the pharmacy counter. --- **Health & Medical Disclaimer:** This article is for informational purposes only and does not provide medical, financial, or legal advice. Always talk with your doctor, pharmacist, Medicare plan provider, or a licensed Medicare counselor before making decisions about cancer treatment or prescription drug coverage.