Publication Date:
2016-12-02
Description:
Background: The introduction of novel parenteral (bortezomib) and oral (lenalidomide and thalidomide) agents in the mid-2000's radically improved the management and outcomes in multiple myeloma. The cost of these drugs typically exceeds $5000/month, posing a financial challenge for patients (pts), insurers and healthcare systems. Medicare beneficiaries in the United States have disparate coverage for parenteral and oral chemotherapy. Coverage for oral agents has been available since 2006 for those purchasing Part D prescription plans (PDP), but such plans impose substantial out-of-pocket expenses through the "donut hole" coverage gap and coinsurance required even in the "catastrophic" phase. Pts with low income can receive the Part D Low Income Subsidy (LIS) which largely eliminates this cost sharing. Our objective was to examine the association of Medicare part D and LIS policies with utilization of, and out-of-pocket burden for, the novel anti-myeloma agents. Methods: From the Surveillance, Epidemiology and End Results data base linked to Medicare claims (2000-2012), we selected pts ≥65 years old, diagnosed with myeloma in 2001-2011, and with fee-for-service Medicare insurance. Pts in the post-Part-D era (2006-2012) were classified according to their prescription coverage at diagnosis as those with: PDP without LIS, PDP with LIS, or no coverage. We identified first-line parenteral chemotherapy (using specific drug codes) and oral agents (assumed from generic follow-up codes for pts without PDP), as well as other relevant covariates: comorbidities, a claims-based performance status indicator, anemia, neuropathy, and use of health services. We then compared parenteral and oral chemotherapy use between pre-Part-D (2001-2005) and post-Part-D (2006-2011) eras, and use of lenalidomide/thalidomide among PDP pts with or without LIS, in multivariable robust Poisson models for relative risk (RR), reporting 95% confidence intervals (CI). Results: Among 19,434 pts (median age, 77 years; 46% women), 52% had a record of any chemotherapy within 1 year from myeloma diagnosis. This proportion increased from 42% in pre-Part-D era to 61% after Part D introduction (adjusted RR, 1.45; CI, 1.41-1.49; P
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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