The Price Elasticity of Specialty Drug Use: Evidence from Cancer Patients in Medicare Part D

Jung, Jeah; Feldman, Roger; McBean, A. Marshall

doi:10.1515/fhep-2016-0007

Cited by 5 publications

(3 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 High OOP expenditures have been associated with decreased TKI access in patients with CML [9][10][11] and also across various cancers that are treated with specialty cancer drugs or oral cancer therapies. [26][27][28][29][30] High OOP expenditures will likely price-out patients whose treatment cost is a large proportion or exceeds income, thus leading to disparities in TKI access.…”

Section: Discussionmentioning

confidence: 99%

Trend in Tyrosine Kinase Inhibitor Utilization, Price, and Out-of-Pocket Costs in Patients With Chronic Myelogenous Leukemia

Talon

Calip

Lee

et al. 2021

JCO Oncology Practice

View full text Add to dashboard Cite

PURPOSE: Treatment of chronic myelogenous leukemia (CML) with tyrosine kinase inhibitors (TKIs) has improved survival but is associated with significant financial burden. We measured the annual trend in TKI utilization, Medicare gross payment, and patient out-of-pocket (OOP) expenditure from 2007 to 2016. METHODS: We used SEER linked to Medicare part-D claims data to identify prevalent CML cases from 2007 to 2016. TKI utilization was measured as the proportion of cases with at least one TKI fill in each year. Average TKI gross payment and median per-member per-month OOP expenditure were calculated from claims data and plotted annually from 2007 to 2016. Year-to-year percent change in gross payment and OOP expenditure was compared with inflation indices. RESULTS: The cohort included 3,189 CML cases with at least one TKI claim. The proportion of prevalent patients with a TKI fill in a year increased from 17.9% in 2007 to 52.8% in 2015. The average annual gross payment per 30-day supply of a TKI increased by an average of 12.8% throughout the period from $9,000 to $10,000 US dollars in 2016. There was no increasing trend in median OOP expenditure per 30-day supply, which varied between $450 and $600 US dollars. CONCLUSION: Rising TKI use and TKI drug prices place considerable financial pressure on Medicare part-D insurers. Although there was no increasing trend in OOP expenditure, it may be burdensome for Medicare patients who are likely retired on a fixed income. Our findings support legislation that mitigates increasing drug prices to protect the Medicare system and its beneficiaries.

show abstract

Section: Discussionmentioning

confidence: 99%

Trend in Tyrosine Kinase Inhibitor Utilization, Price, and Out-of-Pocket Costs in Patients With Chronic Myelogenous Leukemia

Talon

Calip

Lee

et al. 2021

JCO Oncology Practice

View full text Add to dashboard Cite

show abstract

“…Fourth, we did not analyze oral cancer drugs covered by Medicare Part D because physicians do not generate profit or revenue from prescribing oral agents. Jung, Feldman, and McBean () reported that Parts B and D cancer drugs are not substitutes. However, substitution by integrated doctors would imply that the integration effect in our analysis is underestimated.…”

Section: Discussionmentioning

confidence: 99%

The impact of integration on outpatient chemotherapy use and spending in Medicare

2019

Self Cite

View full text Add to dashboard Cite

Hospital–physician integration has substantially grown in the United States for the past decade, particularly in certain medical specialties, such as oncology. Yet evidence is scarce on the relation between integration and outpatient specialty care use and spending. We analyzed the impact of oncologist integration on outpatient provider‐administered chemotherapy use and spending in Medicare, where prices do not depend on providers' integration status or negotiating power. We addressed oncologists' selective integration and patients' nonrandom choice of oncologists using an instrumental variables method. We found that integrated oncologists reduced the quantity of outpatient chemotherapy drugs but used more expensive treatments. This led to an increase in chemotherapy‐drug spending after integration. These findings suggest that changes in treatment patterns—treatment mix and quantity—may be an important mechanism by which integration increases spending. We also found that integration increased spending on chemotherapy administration (the act of injection). This is because integration shifted billing of chemotherapy to hospital outpatient departments, where Medicare payments for chemotherapy administration are higher than those in physician offices. As integration increases, efforts should continue to assess how integration influences patient care and explore policy options to ensure desirable outcomes from integration.

show abstract

“…It also allows us to avoid potential selection that a hospital's having 340B status itself changes the hospital's patient risk: When 340B hospitals develop affiliation with clinics, their patient risk changes because patients from affiliated clinics are moved to the hospitals’ outpatient departments. Accounting for this issue is important because patient risk differs between HOPDs and Offices: for example, the distribution of cancer types differs between the two settings (Avalere Health, ) and patterns of cancer drug use/spending differ by cancer type (Jung, Feldman, and McBean ). However, changes in patient risk in 340B hospitals were not properly addressed in prior work based on a hospital‐level identification approach (Government Accountability Office ; Desai and McWilliams ).…”

Section: Methodsmentioning

confidence: 99%

Impact of the 340B Drug Pricing Program on Cancer Care Site and Spending in Medicare

Jung

Kalidindi

2018

Health Services Research

Self Cite

View full text Add to dashboard Cite

Objective To examine the impact of the 340B drug discount program on the site of cancer drug administration and cancer care spending in Medicare. Data Sources/Study Setting 2010–2013 Medicare claims data for a random sample of Medicare Fee‐for‐Service beneficiaries with cancer. Study Design We identified the 340B effect using variation in the availability of 340B hospitals across markets. We considered beneficiaries from markets that newly gained a 340B hospital during the study period (new 340B markets) as the treatment group. Beneficiaries in markets with no 340B hospital were the control group. We used a difference‐in‐differences approach with market fixed effects. Data Collection Secondary data analysis. Principal Findings The probability of a patient receiving cancer drug administration in hospital outpatient departments (HOPDs) versus physician offices increased 7.8 percentage points more in new 340B markets than in markets with no 340B hospital. Per‐patient spending on other cancer care increased $1,162 more in new 340B markets than in markets with no 340B hospital. Conclusions The 340B program shifted the site of cancer drug administration to HOPDs and increased spending on other cancer care. As the program expands, continuing assessment of its impact on service utilization and spending would be needed.

show abstract

The Price Elasticity of Specialty Drug Use: Evidence from Cancer Patients in Medicare Part D

Cited by 5 publications

References 28 publications

Trend in Tyrosine Kinase Inhibitor Utilization, Price, and Out-of-Pocket Costs in Patients With Chronic Myelogenous Leukemia

Trend in Tyrosine Kinase Inhibitor Utilization, Price, and Out-of-Pocket Costs in Patients With Chronic Myelogenous Leukemia

The impact of integration on outpatient chemotherapy use and spending in Medicare

Impact of the 340B Drug Pricing Program on Cancer Care Site and Spending in Medicare

Contact Info

Product

Resources

About