Medicare beneficiaries with myeloma face 'substantial' financial burden for oral anticancer therapies

The cost of oral anticancer medications presented a “substantial financial barrier” to Medicare beneficiaries with myeloma who did not receive low-income subsidies, according to findings published in Journal of Clinical Oncology.

Researchers added that the lack of access to therapies such as immunomodulatory agents warranted “urgent attention from policymakers.”

“Previous work has shown that Medicare beneficiaries face high out-of-pocket costs for orally administered anticancer medications and typically meet the threshold for catastrophic coverage with the first prescription,” Adam J. Olszewski, MD, of the Alpert Medical School, Brown University, and colleagues wrote. “This means that patients who initiate immunomodulatory drug therapy must pay thousands of dollars in immediate out-of-pocket expenses.”

The researchers used SEER-Medicare data to identify 3,038 Medicare Part D beneficiaries diagnosed with myeloma between 2007 and 2011. Olszewski and colleagues used multivariable models to evaluate associations between low-income subsidies and use of immunomodulatory drugs, delays between prescription refills for immunomodulatory drugs and health outcomes during the first year of therapy.

Overall, 41% of patients received immunomodulatory drugs. Patients without low-income subsidies faced a median out-of-pocket cost of $3,178 for the first prescription, compared with $3 for those who received the subsidy. The median cost for the first year of therapy was $5,623 for unsubsidized patients and $6 for subsidized patients.

A subsidy conferred a 32% greater probability of receipt of immunomodulatory drugs among patients aged 75 to 84 years (95% CI, 16%-47%). Subsidies were also associated with a significantly decreased risk for delay of prescription refills (adjusted RR = 0.54; 95% CI, 0.32-0.92).

Patients with subsidies did not show significantly different lengths of therapy than those without subsidies (median for both, 7.6 months).

Although 1-year OS and cumulative Medicare costs appeared similar between patients who received immunomodulatory drugs and those who did not, patients who received the drugs made fewer emergency department visits and were admitted to the hospital less often.

“Our analysis suggests that subsidies alleviating patients’ financial burden for orally administered chemotherapy may significantly influence treatment selection among certain beneficiaries with myeloma, and their subsequent health outcomes,” the researchers wrote. “Policymakers should recognize that the substantial out-of-pocket expenses may compromise access to cancer therapy and lead to catastrophic levels of spending, thereby undermining one of the purposes of health insurance.” – by Andy Polhamus

Disclosure: Olszewski reports research funding from Genentech, Incyte and TG Therapeutics. Please see the full study for a list of all other researchers’ relevant financial disclosures.