Cost Sharing and Targeted Therapy Among Older Patients With Kidney Cancer
High cost-sharing and the resultant higher out-of-pockets costs are associated with reduced and/or delayed access to targeted therapies among elderly Medicare patients with metastatic renal cell carcinoma, based on the study findings published in Cancer Medicine. Jalpa Doshi, PhD, of the Perelman School of Medicine, University of Pennsylvania, Philadelphia, and colleagues suggest their findings have both clinical and policy implications.
“In keeping with calls for providers to address financial toxicity, our findings highlight the importance of proactive discussions about financial barriers when reviewing treatment options with patients,” they wrote.
The investigators studied Medicare claims from 2011 to 2013 for 1,721 beneficiaries with newly diagnosed metastases in the liver, lung, or bone. They focused on Medicare Part D patients with low out-of-pocket costs due to receipt of full low-income subsidies (LIS) beneficiaries versus those responsible for more than 25% cost sharing during Medicare’s initial coverage phase (non-LIS beneficiaries). Data were assembled on the rates of initiation of targeted treatment and the time to initiation of oral medications (sorafenib, sunitinib, everolimus, pazopanib, or axitinib) covered by the Medicare Part D prescription drug benefit; injected or infused medications (temsirolimus or bevacizumab) covered by the Medicare Part B benefit; and any Part D or Part B targeted therapy.
For initial oral prescriptions, non-LIS patients were responsible for out-of-pocket costs of at least $2,800, compared with $6.60 for LIS patients. Fewer non-LIS patients than LIS patients initiated oral therapies (20.7% vs. 33.9%) and any targeted therapies (26.7% vs. 40.4%). Furthermore, non-LIS patients were slower to access therapy in the first 6 months after a new diagnosis of metastatic renal cell carcinoma.