Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer

Abstract

PURPOSE: The implications of high prices for cancer drugs on health care costs and patients' financial burdens are a growing concern. Patients with metastatic castrate-resistant prostate cancer (mCRPC) are often candidates for multiple first-line systemic therapies with similar impacts on life expectancy. However, little is known about the gross and out-of-pocket (OOP) payments associated with each of these drugs for patients with employer-sponsored health insurance. We therefore aimed to determine the gross and OOP payments of first-line drugs for mCRPC and how the payments vary across drugs. METHODS: This retrospective cohort study included 4,298 patients with prostate cancer who initiated therapy with one of six drugs approved for first-line treatment of mCRPC between July 1, 2013, and June 30, 2019. We compared gross and OOP payments during the 6 months after initiation of treatment for mCRPC using private payer claims data across patients using different first-line drugs. RESULTS: Gross payments varied across drugs. Over the 6 months after the index prescription, mean unadjusted gross drug payments were highest for patients receiving sipuleucel-T ($115,525 USD) and lowest for patients using docetaxel ($12,804 USD). OOP payments were lower than gross drug payments; mean 6-month OOP payments were highest for cabazitaxel ($1,044 USD) and lowest for docetaxel ($296 USD). There was a wide distribution of OOP payments within drug types. CONCLUSION: Drugs for mCRPC are expensive with large differences in payments by drug type. OOP payments among patients with employer-sponsored health insurance are much lower than gross drug payments, and they vary both across and within first-line drug types, with some patients making very high OOP payments. Although lowering drug prices would reduce pharmaceutical spending for patients with mCRPC, decreasing patient financial burden requires understanding an individual patient's benefit design.

Importance of Patient Health Insurance Coverage and Out-of-Pocket Costs for Genomic Testing in Oncologists' Treatment Decisions

“…30 are challenging because health care cost data are rarely available at the point of service, 37 and patient OOP costs vary substantially by patient health insurance coverage type and required deductibles and cost-sharing. [38][39][40][41][42][43] Although prior authorization required by health insurer plans is frequently cited as a barrier to care, 44 it may provide information about expected OOP costs. Price transparency is frequently proposed to improve physician and patient knowledge of expected costs of care.…”

Drug costs: acquisition costs are critical but not the entire story of financial toxicity

“…When considering these data, however, it is important to keep in mind that acquisition costs and drug prices are often different from what insurers pay for a drug on a beneficiary's behalf (and therefore what is likely indirectly passed down to patients through higher premiums); gross payments made by insurers are frequently concealed through complex pricing mechanisms [3]. In addition, patient out-of-pocket payments are not necessarily proportional to insurer payments [2].…”

“…In this study, the acquisition costs for various second‐ and third‐line treatment options for mUC treatment are different. The concept of differing costs across various treatment alternatives also applies to other genitourinary malignancies, such as metastatic castrate‐resistant prostate cancer [2]. These price differences suggest that clinician decision making leads to varying cost implications for patients, insurers and society, and could contribute to differences in patient financial burden.…”