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High OOP Costs for Medicare Patients with Cancer

August 2012 Vol 5, No 5, Special Issue ASCO 2012 Payers' Perspective

Chicago, IL—Older patients with cancer and Medicare coverage often incur greater out-of-pocket (OOP) expenses compared with their counterparts without cancer. Factors contributing to the greater expenses for those patients include comorbidities and lack of supplemental insurance. As a result, older patients often hesitate to seek treatment for cancer because of financial concerns, according to a study presented by Amy J. Davidoff, PhD, MS, Assistant Pro­fessor, Pharmaceutical Health Ser­vices Research, University of Mary­land School of Pharmacy, Balti­more, and colleagues at the 2012 American Society of Clinical Oncology meeting.

The team used Medicare Current Beneficiary Survey (MCBS) data from 1997 to 2007 that was linked to Medicare claims for their analysis. Pa­tients with a new diagnosis of can­­­cer were chosen based on Inter­national Classification of Diseases, Ninth Re­vision, Clinical Modification (ICD-9-CM) codes on claims after a 12-month washout period subsequent to the cancer diagnosis. OOP costs were noted via the patients’ own reporting.

The study included 1869 Medicare beneficiaries with cancer and 10,057 without cancer. Those with cancer tended to be older, have more comorbidities, and typically did not have supplemental insurance compared with those without cancer.

For a patient with cancer, the total OOP spending was $4727 (11.4% of total spending); the OOP difference between patients with and without cancer was $1518. After adjusting for patient characteristics, those with cancer had an incremental increase of $956 in OOP cost.

Among patients with cancer, approximately 28% spent ≥20% of their income on OOP expenses compared with 16% of those without cancer who used ≥20% of their income on OOP expenses.

Comorbid conditions, undergoing cancer-specific radiation therapy, re­ceiving antineoplastic therapy, and having greater assets led to more OOP expense.

Supplemental Insurance
A separate analysis of the same MCBS database showed that the use of antineoplastic therapy among Medi­care recipients is influenced by the availability, but not the type, of supplemental coverage. This analysis—based in large part on data before the addition of Medicare Part D (in 2006)—demonstrated that oral antineoplastic agents were received by many patients with cancer using antineoplastic therapy (non–Part B drugs), yet there was less spending on this therapy than on infused/injected chemotherapy (Part B drugs). There were no notable differences in use or spending on antineoplastic therapy for the post–Part D period relative to the reference period.

“With the large number of relatively new oral prescription antineoplastic agents, and with more in the pipeline, monitoring the role of supplemental insurance, and particularly the role of Part D in access and spending, is a critical area for ongoing research,” said Dr Davidoff.

For this retrospective analysis, community-based MCBS participants with new cancer diagnoses were chosen based on ICD-9-CM diagnosis codes. A total of 1836 beneficiaries who had a new diagnosis of cancer were enrolled.

Of the 559 patients who were treated with antineoplastic therapy, 395 (21.5%) received infused/injected chemotherapy and 254 received oral antineoplastic agents. Patients using antineoplastic therapy spent $7841 (any coverage), $10,364 (Part B coverage), and $1535 (non–Part B coverage).

If beneficiaries had supplemental coverage, the antineoplastic therapy rates and spending were greater relative to those who did not have supplemental coverage. After adjustment, patients with supplemental insurance from any source were more likely to receive treatment for cancer.
A major predictor of antineoplastic therapy use and spending was the site of the cancer. Also, older age was associated with less spending.

Last modified: August 30, 2021