Background: Rising pharmaceutical costs threaten affordability and access to cancer care. Methods: The 2013 and 2015 Medicare Part D claims databases were queried for CareFirst’s 2017 list of oral cancer drugs. Drugs with on-label indications for conditions other than cancer were excluded. Cost in 2013 were adjusted for inflation to 2015 dollars according to the Bureau of Labor Statistics consumer price index. Results: The total cost of oral cancer drugs paid by Medicare nearly doubled from 2013 to 2015, rising from over $4.8 billion to over $9.1 billion. The number of prescriptions increased by 21.6% from 640,193 to 778,357, suggesting that increased spending is driven more by rising drug prices than by increased utilization. Cost per patient increased for 81% (46) of the 57 drugs prescribed in both years and decreased for the remaining 19% (11). While only seven drugs cost more than $50,000 per patient in 2013, more than fifteen drugs cost more than $50,000 per patient in 2015. The overall average cost per beneficiary increased by 56% from $7,521.64 to $11,734.68, and seven drugs more than doubled in per patient cost. Cost per patient increased by 4.5 times for imbruvica (ibrutinib), 3.5 times for targretin (bexarotene), 3.2 times for soltamox (tamoxifen citrate), 3.1 times for nilandron (nilutamide), 2.6 times for gilotrif (afatinib dimaleate), 2.6 times for cyclophosphamide, and 2.5 times for iclusig (ponatinib hydrochloride). Conclusions: Medicare costs for oral cancer drug nearly doubled from 2013 to 2015, largely due to increased per patient costs.

*Brand names and generics, where applicable, were considered separately