Yi-Ting Chou1, Joel F Farley2, Thomas E Stinchcombe3, Amber E Proctor4,5, Jennifer Elston Lafata1,6, Stacie B Dusetzina7,8. 1. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC. 2. Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN. 3. Department of Medicine, Division of Medical Oncology, Duke Cancer Institute, Durham, NC. 4. Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC. 5. Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC. 6. UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC. 7. Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN. 8. Vanderbilt-Ingram Cancer Center, Nashville, TN.
Abstract
BACKGROUND: High out-of-pocket costs may impact anticancer treatment uptake. The Low-Income Subsidy (LIS) program can reduce patient out-of-pocket cost for Medicare Part D-covered treatments. We examined whether the LIS increased uptake and reduced time to initiate orally administered anticancer drugs in patients with advanced non-small cell lung cancer (NSCLC). METHODS: Using Surveillance, Epidemiology and End Results (SEER)-Medicare data, we identified older adults (aged 65 years and older) diagnosed with advanced NSCLC from 2007 through 2013 and categorized them as full LIS, partial LIS, or non-LIS. We used propensity-score weighted (IPTW) Cox proportional hazards regression to assess the likelihood of and time to initiate Part D treatments. Part B medication uptake was our negative control because supplemental insurance reduces out-of-pocket costs for those drugs. All statistical tests were two-sided. RESULTS: Among 19 746 advanced NSCLC patients, approximately 10% initiated Part D treatments. Patients with partial or no LIS were less likely to initiate Part D treatments than were those with full subsidies (partial LIS vs full LIS HRIPTW = 0.77, 95% confidence interval = 0.62 to 0.97; non-LIS vs full LIS HRIPTW = 0.87, 95% confidence interval = 0.79 to 0.95). Time to initiate Part D treatments was also slightly shorter among full-LIS patients (full LIS mean [SD] = 10.8 [0.04] months; partial LIS mean [SD] = 11.3 [0.08] months; and non-LIS mean [SD] = 11.1 [0.03] months, P < .001). Conversely, patients with partial or no LIS had shorter time to initiation of Part B drugs. CONCLUSIONS: Patients receiving the full LIS had higher orally administered anticancer treatment uptake than patients without LIS. Notably, patients with partial LIS had the lowest treatment uptake, likely because of their low incomes combined with high expected out-of-pocket spending. High out-of-pocket costs for Part D medications may be a barrier to treatment use for patients without full LIS.
BACKGROUND: High out-of-pocket costs may impact anticancer treatment uptake. The Low-Income Subsidy (LIS) program can reduce patient out-of-pocket cost for Medicare Part D-covered treatments. We examined whether the LIS increased uptake and reduced time to initiate orally administered anticancer drugs in patients with advanced non-small cell lung cancer (NSCLC). METHODS: Using Surveillance, Epidemiology and End Results (SEER)-Medicare data, we identified older adults (aged 65 years and older) diagnosed with advanced NSCLC from 2007 through 2013 and categorized them as full LIS, partial LIS, or non-LIS. We used propensity-score weighted (IPTW) Cox proportional hazards regression to assess the likelihood of and time to initiate Part D treatments. Part B medication uptake was our negative control because supplemental insurance reduces out-of-pocket costs for those drugs. All statistical tests were two-sided. RESULTS: Among 19 746 advanced NSCLCpatients, approximately 10% initiated Part D treatments. Patients with partial or no LIS were less likely to initiate Part D treatments than were those with full subsidies (partial LIS vs full LIS HRIPTW = 0.77, 95% confidence interval = 0.62 to 0.97; non-LIS vs full LIS HRIPTW = 0.87, 95% confidence interval = 0.79 to 0.95). Time to initiate Part D treatments was also slightly shorter among full-LISpatients (full LIS mean [SD] = 10.8 [0.04] months; partial LIS mean [SD] = 11.3 [0.08] months; and non-LIS mean [SD] = 11.1 [0.03] months, P < .001). Conversely, patients with partial or no LIS had shorter time to initiation of Part B drugs. CONCLUSIONS:Patients receiving the full LIS had higher orally administered anticancer treatment uptake than patients without LIS. Notably, patients with partial LIS had the lowest treatment uptake, likely because of their low incomes combined with high expected out-of-pocket spending. High out-of-pocket costs for Part D medications may be a barrier to treatment use for patients without full LIS.
Authors: Jalpa A Doshi; Pengxiang Li; Hairong Huo; Amy R Pettit; Rishab Kumar; Brenda M Weiss; Scott F Huntington Journal: Am J Manag Care Date: 2016-03 Impact factor: 2.229
Authors: Amy J Davidoff; Ilene H Zuckerman; Naimish Pandya; Franklin Hendrick; Xuehua Ke; Arti Hurria; Stuart M Lichtman; Arif Hussain; Jonathan P Weiner; Martin J Edelman Journal: J Geriatr Oncol Date: 2013-04 Impact factor: 3.599
Authors: S Yousuf Zafar; Jeffrey M Peppercorn; Deborah Schrag; Donald H Taylor; Amy M Goetzinger; Xiaoyin Zhong; Amy P Abernethy Journal: Oncologist Date: 2013-02-26
Authors: Megan E V Caram; Mary K Oerline; Stacie Dusetzina; Lindsey A Herrel; Parth K Modi; Samuel R Kaufman; Ted A Skolarus; Brent K Hollenbeck; Vahakn Shahinian Journal: Cancer Date: 2020-09-14 Impact factor: 6.860