Medicare Part D low-income subsidy and disparities in breast cancer treatment.

2 Background: Breast cancer outcomes are worse among black than white women, but the role of income and out-of-pocket costs (OOPCs) in these disparities is understudied. The Medicare D program provided medication insurance for older women and also included a low-income subsidy (LIS) which eliminated or reduced OOPCs among women with low assets and limited income (based on federal poverty level). We examined differences in adherence to HT by race/ethnicity among a Medicare D population, hypothesizing that LIS might reduce racial disparities in HT adherence. Methods: With data collected from a national sample of women enrolled in Medicare Parts A, B, and D, we identified Medicare Part D enrollees ≥65 years diagnosed with breast cancer who underwent mastectomy or breast conserving surgery in 2006-07 and received either tamoxifen or an AI (anastrozole, letrozole, or exemestane) within one year of surgery. Nonadherence rates (medication possession rate of >0.80) were calculated by race and LIS status for each year after first fill up through December 2011. The association of race with HT adherence was examined in unadjusted Chi-square analyses and in regression models adjusted for age, comorbidity, chemotherapy use, and zip code level- income and education. All models utilized GEE to account for within-patient clustering. Results: Among a sample of 23,299 women (50.6% age 65-74, 40.9% age 75-84), 27.2% received LIS. LIS (but not AI use) varied substantially by race, so that 20.6% of white women and 69.7% of black women received the subsidy. In the first year of therapy, differences in adherence by race were statistically significant, but small (64.2% for white, 63.2% for black and 66.7% for Hispanic). Adherence dropped during years 2-3 of the study, but reductions were much smaller among LIS recipients. Results were confirmed in adjusted models. Conclusions: Enrollment in the Medicare D LIS was high among black and Hispanic breast cancer patients, and disparities in adherence to breast cancer HT among these women were small and remained so over three years. Our study offers important information about the role of medication subsidies and SES in adherence, and suggests their potential to reduce the breast cancer outcomes gap by race.

Download Full-text

Using Matched Survey and Administrative Data to Estimate Eligibility for the Medicare Part D Low Income Subsidy Program

10.7249/wr743 ◽

2010 ◽

Cited By ~ 3

Author(s):

Erik Meijer ◽

Lynn Karoly ◽

Pierre-Carl Michaud

Keyword(s):

Administrative Data ◽

Low Income ◽

Medicare Part D ◽

Medicare Part ◽

Part D ◽

Subsidy Program

Download Full-text

Patient costs of breast cancer endocrine therapy agents under Medicare Part D vs with generic formulations

SpringerPlus ◽

10.1186/s40064-015-0827-8 ◽

2015 ◽

Vol 4 (1) ◽

Cited By ~ 7

Author(s):

Ann Butler Nattinger ◽

Liliana E Pezzin ◽

Emily L McGinley ◽

John A Charlson ◽

Tina W F Yen ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Medicare Part D ◽

Medicare Part ◽

Part D ◽

Patient Costs

Download Full-text

HOW DO FORMULARY RESTRICTIONS AFFECT MEDICATION USE AND COSTS FOR LOW-INCOME SUBSIDY RECIPIENTS IN MEDICARE PART D PLANS?

Value in Health ◽

10.1016/j.jval.2016.03.795 ◽

2016 ◽

Vol 19 (3) ◽

pp. A261

Author(s):

X. Shen ◽

B. Stuart ◽

C. Powers ◽

S. Tom ◽

L. Magder ◽

...

Keyword(s):

Low Income ◽

Medication Use ◽

Medicare Part D ◽

Medicare Part ◽

Part D

Download Full-text

Endocrine Therapy Use Among Elderly Hormone Receptor-Positive Breast Cancer Patients Enrolled in Medicare Part D

Medicare & Medicaid Research Review ◽

10.5600/mmrr.001.04.a04 ◽

2011 ◽

Vol 1 (4) ◽

pp. E1-E26 ◽

Cited By ~ 39

Author(s):

Gerald Riley ◽

Joan Warren ◽

Linda Harlan ◽

Steven Blackwell

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Endocrine Therapy ◽

Hormone Receptor ◽

Medicare Part D ◽

Medicare Part ◽

Breast Cancer Patients ◽

Part D ◽

Hormone Receptor Positive ◽

Positive Breast Cancer

Download Full-text

Financial hardship among Medicare beneficiaries prescribed oral targeted therapies for advanced prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.68 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 68-68

Author(s):

Megan Veresh Caram ◽

Mary Oerline ◽

Stacie Dusetzina ◽

Parth K. Modi ◽

Lindsey A. Herrel ◽

...

Keyword(s):

Prostate Cancer ◽

Low Income ◽

Advanced Prostate Cancer ◽

Medicare Part D ◽

Financial Hardship ◽

Medicare Part ◽

Regional Variability ◽

Part D ◽

Hospital Referral Region ◽

Hospital Referral

68 Background: Abiraterone and enzalutamide are increasingly being used to treat advanced prostate cancer. Understanding barriers to adhering to treatment is of paramount importance in ensuring continued access to these important therapies. Patients with limited resources or insufficient access to mechanisms that lower their out-of-pocket cost are likely to suffer from significant financial toxicity and may engage in coping mechanisms such as rationing or abandoning their medication. Methods: To address the variability in measures of financial hardship, we performed a retrospective cohort study on a 20% sample of patients eligible for Medicare Part D who received their first fill of abiraterone or enzalutamide between July 2013 and June 2015. Patients were assigned to a provider based on their first prescription, and a hospital referral region (HRR) based on their ZIP code. The primary outcomes were to determine the proportion of days covered (PDC), overall prescription adherence, and average monthly out-of-pocket cost to patients prescribed abiraterone or enzalutamide, all within the first six months of treatment. Results: From mid-2013 to mid-2015, 4529 patients filled abiraterone or enzalutamide through Medicare Part D, within 305 HRRs. There was substantial variability in PDC, adherence, and out-of-pocket cost to patients among HRRs. The mean PDC was 84% with mean adherence of 73%, which included the 393 (8.7%) of patients who abandoned oral therapy after 1-2 fills. The median standard monthly out-of-pocket cost was $707, ranging between $0 and $3505. Among patients with low-income subsidies, median out-of-pocket cost by HRR ranged from $0 to $2815. We observed that PDC tracked closely with socioeconomic status – HRRs that included a higher proportion of patients eligible for Medicaid had lower PDCs and adherence, but lower standard out-of-pocket cost. Conclusions: This investigation demonstrated significant variation in PDC, adherence, and out-of-pocket cost among different HRRs for patients prescribed abiraterone and enzalutamide and that much of the variability in financial hardship measures among HRRs may be due to socioeconomic variables and regional variability.

Download Full-text

National Utilization Patterns of Warfarin Use in Older Patients with Atrial Fibrillation: A Population-Based Study of Medicare Part D Beneficiaries

Annals of Pharmacotherapy ◽

10.1345/aph.1r515 ◽

2013 ◽

Vol 47 (1) ◽

pp. 35-42 ◽

Cited By ~ 27

Author(s):

Mukaila A Raji ◽

Matthew Lowery ◽

Yu-Li Lin ◽

Yong-Fang Kuo ◽

Jacques Baillargeon ◽

...

Keyword(s):

Atrial Fibrillation ◽

Low Income ◽

Medicare Part D ◽

Patient Characteristics ◽

Population Based ◽

Medicare Part ◽

Part D ◽

Stroke Incidence ◽

Hospital Referral ◽

Geographic Regions

BACKGROUND Although warfarin therapy reduces stroke incidence in patients with atrial fibrillation (AF), the rate of warfarin use in this population remains low. In 2008, the Medicare Part D program was expanded to pay for medications for Medicare enrollees. OBJECTIVE To examine rates and predictors of warfarin use in Medicare Part D beneficiaries with AF. METHODS This population-based retrospective cohort study used claims data from 41,447 Medicare beneficiaries aged 66 and older with at least 2 AF diagnoses in 2007 and at least 1 diagnosis in 2008. All subjects had continuous Medicare Part D prescription coverage in 2008. Statistical analysis using χ2 was used to examine differences in warfarin use by patient characteristics (age, ethnicity, sex, Medicaid eligibility, comorbidities, contraindications to warfarin, and whether they visited a cardiologist or a primary care physician [PCP]), CHADS2 score (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack; higher scores indicate higher risks of stroke), and geographic regions. Using hierarchical generalized linear models restricted to subjects without warfarin contraindications (n = 34,947), we examined the effect of patient characteristics and geographic regions on warfarin use. RESULTS The overall warfarin use rate was 66.8%. The warfarin use rates varied between hospital referral regions, with highest rates in the Midwestern states and lowest rates in the South. The regional variation persisted even after adjustment for patient characteristics. Multivariable analysis showed that the odds of being on warfarin decreased significantly with age and increasing comorbidity, in blacks, and among those with low income. Seeing a cardiologist (OR 1.10; 95% CI 1.05–1.16), having a PCP (OR 1.23; 95% CI 1.17–1.29), and CHADS2 score of 2 or greater (OR 1.09; 95% CI 1.01–1.17) were associated with increased odds of warfarin use. CONCLUSIONS Warfarin use rates vary by patient characteristics and region, with higher rates among residents of the Midwest and among patients seen by cardiologists and PCPs. Preventing stroke-related disability in AF requires implementation of evidence-based initiatives to increase warfarin use.

Download Full-text