Evaluation of Trends in Oncology Drug Spending in Medicare, 2016 to 2020

Kyle, Michael Anne; Dusetzina, Stacie B.; Keating, Nancy L.

doi:10.1001/jamanetworkopen.2022.21468

Cited by 8 publications

(14 citation statements)

References 4 publications

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“…Utilization management is entwined with spending: it was most prevalent among specialty drugs—the most costly and least affordable to patients . Utilization management may be appropriate for some oncology drugs, such as those approved with provisional evidence of efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Utilization management—such as prior authorization—is prevalent, and evidence from medical services indicates it disproportionately affects oncology treatments . Orally administered cancer drugs are increasing in number and cost . These products have mandatory coverage in Medicare Part D as a protected class; less is known about utilization management.…”

mentioning

confidence: 99%

“…1 Orally administered cancer drugs are increasing in number and cost. 2 These products have mandatory coverage in Medicare Part D as a protected class; less is known about utilization management. Utilization management introduces administrative burdens on clinicians and patients to monitor or modify utilization, which can lead to delayed or forgone care.…”

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confidence: 99%

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Utilization Management Trends in Medicare Part D Oncology Drugs, 2010-2020

Kyle

Dusetzina

Keating

2023

JAMA

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Utilization Management Trends in Medicare Part D Oncology Drugs, 2010-2020

Kyle

Dusetzina

Keating

2023

JAMA

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“…For example, oncology drugs covered under prescription drug benefit (Part D) represented 0.6% of sales volume but 13.2% of Medicare Part D spending as of 2020. 3 When patients experience high costs of oncologic care, they frequently suffer from financial toxicity manifesting as skipping doses, not filling prescriptions, taking on significant medical debt, experiencing anxiety or depression, and reducing spending in areas such as food and housing. 4 Financial toxicity in oncologic care leads to negative clinical outcomes including worsened symptoms, decreased quality of life, and increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Projected Savings for Generic Oncology Drugs Purchased via Mark Cuban Cost Plus Drug Company Versus in Medicare

Cortese

Dusetzina

Luckenbaugh

et al. 2023

JCO

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PURPOSE Self-administered oncology drugs contribute disproportionately to Medicare Part D spending; prices often remain high even after generic entry. Outlets for low-cost drugs such as Mark Cuban Cost Plus Drug Company (MCCPDC) offer opportunities for decreased Medicare, Part D, and beneficiary spending. We estimate potential savings if Part D plans obtained prices such as those offered under the MCCPDC for seven generic oncology drugs. METHODS Using the 2020 Medicare Part D Spending dashboard, Q3-2022 Part D formulary prices, and Q3-2022 MCCPDC prices for seven self-administered generic oncology drugs, we estimated Medicare savings by replacing Q3-2022 Part D unit costs with costs under the MCCPDC plan. RESULTS We estimate potential savings of $661.8 million (M) US dollars (USD; 78.8%) for the seven oncology drugs studied. Total savings ranged from $228.1M USD (56.1%) to $2,154.5M USD (92.4%) compared with 25th and 75th percentiles of Part D plan unit prices. The median savings replacing Part D plan prices were abiraterone $338.0M USD, anastrozole $1.2M USD, imatinib 100 mg $15.6M USD, imatinib 400 mg $212.0M USD, letrozole $1.9M USD, methotrexate $26.7M USD, raloxifene $63.8M USD, and tamoxifen $2.6M USD. All 30-day prescription drug prices offered by MCCPDC generated cost savings except for three drugs offered at the 25th percentile Part D formulary pricing: anastrozole, letrozole, and tamoxifen. CONCLUSION Replacing current Part D median formulary prices with MCCPDC pricing could yield significant savings for seven generic oncology drugs. Individual beneficiaries could save nearly $25,200 USD per year for abiraterone or between $17,500 USD and $20,500 USD for imatinib. Notably, Part D cash-pay prices for abiraterone and imatinib under the catastrophic phase of coverage were still more expensive than baseline MCCPDC prices.

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“…Pathways are intended to promote standardization in prescribing of systemic cancer treatments with resulting improvements in care quality and reduced cost. [1][2][3] AIM Specialty Health launched the Cancer Care Quality Program (CCQP) in 14 states in July 2014. Program-endorsed or on-pathway regimens comprise a subset of evidence-based regimens chosen across a hierarchy of three priorities: efficacy, toxicity, and cost (see more details in the Data Supplement, online only).…”

Section: Introductionmentioning

confidence: 99%

Association Between Oncology Clinical Pathway Utilization and Toxicity and Cost Outcomes in Patients With Metastatic Solid Tumors

Liu¹,

Mullangi

Debono³

et al. 2023

JCO Oncology Practice

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PURPOSE This retrospective observational study compared cancer care toxicity and cost outcomes for patients with metastatic cancer with nine different cancer types prescribed on- versus off-pathway regimens. METHODS This study used claims and authorization data from a national insurer between January 1, 2018, and October 31, 2021. Participants included adults with metastatic breast, lung, colorectal, pancreatic, melanoma, kidney, bladder, gastric, or uterine cancer, who were prescribed first-line anticancer regimens. Multivariable regressions were used to assess outcomes including counts of emergency room visits or hospitalizations, use of supportive care medications, immune-related adverse events (IRAEs), and health care costs. RESULTS Of the 8,357 patients in the study, 5,453 (65.3%) were prescribed on-pathway regimens. The on-pathway proportion trended downward, from 74.3% in 2018 to 59.8% in 2021. The on- and off-pathway groups had a similar proportion of patients with treatment-related hospitalization (adjusted odds ratio [aOR], 1.080; P = .201) and IRAEs (aOR, 0.961; P = .497). More all-cause hospitalizations (aOR, 1.679; P = .013) were observed among patients with melanoma treated on-pathway. The on-pathway group had higher use of supportive care drugs in bladder cancer (aOR, 4.602; P < .001) and colorectal cancer (aOR, 4.465; P < .001), and lower use in breast (aOR, 0.668; P = .001) and lung cancer (aOR, 0.550; P < .001). On average, on-pathway patients incurred $17,589 less total health care cost ( P < .001), and $22,543 lower chemotherapy cost ( P < .001) than those from the off-pathway group. CONCLUSION Our findings suggest that use of on-pathway regimens was associated with significant cost savings. Toxicity outcomes were variable by disease, but overall, there were similar numbers of treatment-related hospitalizations and IRAEs compared to off-pathway regimens. This cross-institutional study provides evidence to support the use of clinical pathway regimens for patients with metastatic cancer.

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Evaluation of Trends in Oncology Drug Spending in Medicare, 2016 to 2020

Abstract: This cross-sectional study examines trends in drug spending in Medicare Parts B and D and describes the share of total use and spending attributed to oncology drugs within each program.

Cited by 8 publications

References 4 publications

Utilization Management Trends in Medicare Part D Oncology Drugs, 2010-2020

Utilization Management Trends in Medicare Part D Oncology Drugs, 2010-2020

Projected Savings for Generic Oncology Drugs Purchased via Mark Cuban Cost Plus Drug Company Versus in Medicare

Association Between Oncology Clinical Pathway Utilization and Toxicity and Cost Outcomes in Patients With Metastatic Solid Tumors

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