In a study reported in JCO Oncology Practice, Ziakas et al found that Medicare Part D spending on oncology drugs increased markedly between 2013 and 2017, with spending increasing at a rate markedly greater than that attributed to all other medical care providers.
Study Details
Medicare Part D administrative data were used to determine prescribing patterns and attributed drug costs of oncologists from 2013 to 2017. Spending was also analyzed by location quotient (LQ) for hospital referral regions (HRRs): LQ significantly > 1 indicated overrepresentation of oncologists compared with national average, LQ significantly < 1 indicated underrepresentation, and other values indicated average representation.
Analysis by quality of care was performed using U.S. News & World Report for 2017–2018 to rank hospital cancer care. Costs were reported in inflation-adjusted 2017 U.S. dollars.
Study Findings
KEY POINTS
- Medicare Part D drug spending was approximately $154.7 billion in 2017, with approximately $12.8 billion (8.3%) spent on drugs prescribed by oncologists.
- Oncology contributed a higher annual growth in Part D drug costs compared with all other providers (15.1% and 3.1%, respectively, for 2017).
- The top three prescribed drugs increased cost by approximately $3.5 billion from 2013 to 2017.
The investigators found that Medicare Part D drug spending was approximately $154.7 billion in 2017, with approximately $12.8 billion (8.3%) spent on drugs prescribed by oncologists. Oncology spending increased by $7.3 billion from $5.5 billion (5.0% of all Part D spending) in 2013. In 2017, growth in spending was 15.1% for oncologists vs 3.1% for all other providers, representing a decrease in growth from rates of 28.8% vs 14.2% in 2014.
For hematologists/oncologists and medical oncologists combined, Part D drug cost per claim increased from a median of $549.9 in 2013 to a median of $1,131.4 in 2017. Cost per claim in 2017 was approximately 20 times greater than the median cost per claim of $51.0 among all nononcologists. The top three prescribed drugs (lenalidomide, ibrutinib, and palbociclib) increased cost by approximately $3.5 billion from 2013 to 2017.
Oncologists were overrepresented in 22 HRRs, underrepresented in 77 HRRs, and had average representation in 207 HRRs. Among the 20 best-performing cancer centers in 2017–2018, 14 (70%) were located in areas with high LQ and 6 (30%) in areas with average LQ. Median Part D spending as the percentage of regional spending was 9.7% in HRRs with high LQ vs 6.2% in HRRs with low LQ (P < .001); median spending was 8.2% for HRRs with average LQ.
The investigators concluded: “Oncology increased its share in Part D drug spending, disproportionately to all other providers, with regional differences partially moderated by the oncology workforce and quality of cancer care.”
Eleftherios Mylonakis, MD, MSc, PhD, of Warren Alpert Medical School of Brown University, is the corresponding author for the JCO Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
