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

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.

scholarly journals Early national dissemination of abiraterone and enzalutamide for advanced prostate cancer in Medicare Part D.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 35-35
Author(s):  
Megan Veresh Caram ◽  
Tudor Borza ◽  
Hye-Sung Min ◽  
Jennifer J. Griggs ◽  
David Christopher Miller ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Regional Variation ◽  
Advanced Prostate Cancer ◽  
Medicare Part D ◽  
The United States ◽  
Medicare Part ◽  
Part D ◽  
Hospital Referral ◽  
Early National

35 Background: Abiraterone and enzalutamide are oral medications approved by the Food & Drug Administration in 2011 and 2012 to treat men with advanced castration-resistant prostate cancer. Most men with advanced prostate cancer are over age 65 and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D data. Methods: We evaluated the number of prescriptions for abiraterone and enzalutamide by provider specialty and hospital referral region (HRR) using Medicare Part D and Dartmouth Atlas data. We categorized HRRs by abiraterone and enzalutamide prescriptions, adjusted for prostate cancer incidence, and examined factors associated with regional variation using multilevel regression models. Results: Among all providers who wrote prescriptions for abiraterone or enzalutamide in 2013 (n=2121), 87.5% were medical oncologists, 3.3% urologists, and 9.2% were listed as other provider specialties. Among those who prescribed either drug, 5% of providers were responsible for 75% of the claims for abiraterone, and 7% were responsible for 75% of the claims for enzalutamide. Some HRRs demonstrated low-prescribing rates despite average medical oncology and urology physician workforce density. Conclusions: The majority of prescriptions written for abiraterone and enzalutamide through Medicare Part D in 2013 were written by a minority of providers with marked regional variation across the United States. Better understanding the early national dissemination of these effective but expensive drugs can help inform strategies to optimize introduction of new, evidence-based advanced prostate cancer treatments.

scholarly journals Early National Dissemination of Abiraterone and Enzalutamide for Advanced Prostate Cancer in Medicare Part D

2017 ◽  
Vol 13 (8) ◽  
pp. e694-e702 ◽  
Author(s):  
Megan E.V. Caram ◽  
Tudor Borza ◽  
Hye-Sung Min ◽  
Jennifer J. Griggs ◽  
David C. Miller ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Regional Variation ◽  
Medicare Part D ◽  
The United States ◽  
Medicare Part ◽  
Castration Resistant Prostate Cancer ◽  
Part D ◽  
Hospital Referral ◽  
Early National

Introduction: Abiraterone and enzalutamide were approved by the Food and Drug Administration in 2011 and 2012 to treat men with metastatic castration-resistant prostate cancer (mCRPC). Most men with mCRPC are > 65 years of age and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D data. Methods: We evaluated the number of prescriptions for abiraterone and enzalutamide by provider specialty and hospital referral region (HRR) using Medicare Part D and Dartmouth Atlas data. We categorized HRRs by abiraterone and enzalutamide prescriptions, adjusted for prostate cancer incidence, and examined factors associated with regional variation using multilevel regression models. Results: Among providers who wrote the majority of prescriptions for abiraterone or enzalutamide in 2013 (n = 2,121), 87.5% were medical oncologists, 3.3% were urologists, and 9.2% were other provider specialties. Among prescribers, approximately 30% were responsible for three quarters of the claims for abiraterone and 20% were responsible for more than half the claims for enzalutamide. Some HRRs demonstrated low-prescribing rates despite average medical oncology and urology physician workforce density. Our multilevel model demonstrated that regional factors potentially influenced variation in care. Conclusion: The majority of prescriptions written for abiraterone and enzalutamide through Medicare Part D in 2013 were written by a minority of providers, with marked regional variation across the United States. Better understanding of the early national dissemination of these effective but expensive drugs can help inform strategies to optimize introduction of new, evidence-based mCRPC treatments.

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

2013 ◽  
Vol 47 (1) ◽  
pp. 35-42 ◽  
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.

scholarly journals Geographic Variation in the Prevalence of High-Risk Medication Use Among Medicare Part D Beneficiaries by Hospital Referral Region

2020 ◽  
Vol 26 (10) ◽  
pp. 1309-1316
Author(s):  
Chanadda Chinthammit ◽  
Sandipan Bhattacharjee ◽  
David R. Axon ◽  
Marion Slack ◽  
John P. Bentley ◽  
...  
Keyword(s):  
High Risk ◽  
Geographic Variation ◽  
Medication Use ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D ◽  
Hospital Referral Region ◽  
Hospital Referral

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

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

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

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. 6534-6534
Author(s):  
Alana Biggers ◽  
Joan Neuner ◽  
Elizabeth Smith ◽  
Liliana Pezzin ◽  
Purushottam Laud ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Low Income ◽  
Medicare Part D ◽  
Breast Cancer Treatment ◽  
Medicare Part ◽  
Part D

Evaluating financial burdens of oral hormonal therapies for patients with prostate cancer.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 70-70
Author(s):  
Eric B Schwartz ◽  
Angelina Jeong ◽  
Andrea Roman ◽  
Rachel McDevitt ◽  
Elyssa Henry ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Medicare Part D ◽  
Free Drug ◽  
Financial Assistance ◽  
Medicare Part ◽  
Comprehensive Cancer Center ◽  
Part D ◽  
Commercial Insurance ◽  
Initial Cost ◽  
Insured Patients

70 Background: Numerous oral anticancer drugs approved for metastatic prostate cancer are expensive and put patients at risk for financial toxicity. Mechanisms available to mitigate these costs are complex to navigate. Furthermore, the ability to access these resources may not be the same for every insurance. We examined the out-of-pocket (OOP) liability of patients prescribed abiraterone or enzalutamide, the assistance mechanisms used, and the impact on timing of therapy. Methods: Patients with prostate cancer who were prescribed abiraterone or enzalutamide at our comprehensive cancer center between January 1, 2017 and March 31, 2019 were identified. Patients who filled prescriptions via an external pharmacy were excluded. Data regarding demographics, out of pocket costs and assistance mechanisms were evaluated. Results: We identified 219 patients. Of these, 33% had commercial insurance, 61% had Medicare part D, 3% had Medicaid and 8% had no insurance. Most patients (74%) were prescribed abiraterone and 26% enzalutamide. Among those with Medicare Part D, almost one third received significant financial assistance: 11% free drug from the manufacturer and 18% foundational grants. Patients with commercial insurance received a copay card from manufacturers 21% of the time. Patients with commercial insurance paid an average of $57 OOP; 94% with initial cost < $100. Patients with Medicare part D paid an average of $582 OOP; 22% with initial cost > $1000. Commercially insured patients started treatments in under 10 days from the prescription date 51% of the time vs 39% for Medicare patients. In contrast, 11% of commercially insured patients required > 30 days to fill vs 19% on Medicare. Only 1% of commercially insured patients were unable to fill due to cost issues compared to 7% of patients on Medicare. Conclusions: Financial assistance mechanisms such as grants and free drug programs help alleviate some financial burden for patients, but many still experience high OOP costs. These burdens appear to be disproportionately experienced by patients with Medicare Part D. We observed that patients with Medicare Part D had higher OOP costs for oral prostate cancer therapies. Those who required assistance often experienced delays in obtaining medication. Further evaluation is planned into how high costs and delays in treatment impacts prostate cancer treatment and patient care. [Table: see text]

scholarly journals Eligibility and Take-up of the Medicare Part D Low-Income Subsidy

2012 ◽  
Vol 49 (3) ◽  
pp. 214-230 ◽  
Author(s):  
J. Samantha Shoemaker ◽  
Amy J. Davidoff ◽  
Bruce Stuart ◽  
Ilene H. Zuckerman ◽  
Eberechukwu Onukwugha ◽  
...  
Keyword(s):  
Low Income ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D
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