A new study examining the use of high-cost drugs among patients with colorectal cancer and non–small cell lung cancer (NSCLC) found those insured through Medicare Advantage received less expensive cancer drugs compared to others on traditional Medicare. The findings were published by Bradley et al in JAMA Health Forum.
“Lung cancer is the leading cause of cancer-related deaths in the United States, and colorectal cancer ranks third. Gaining a better understanding of treatment options and their costs under different insurance plans is important for assessing the overall health-care landscape and how insurances manage patient costs,” said the study’s first author Cathy Bradley, PhD, Dean of the Colorado School of Public Health.
The study found Medicare Advantage patients received less expensive cancer drugs, particularly for colorectal cancer, when compared to patients on traditional Medicare. Conversely, for patients with NSCLC, the researchers found there are fewer low-cost treatment alternatives available, resulting in the use of high-cost drugs—regardless of insurance type.
“We are among the first to explore how cancer treatments differ for patients enrolled in Medicare Advantage compared to traditional Medicare, which is crucial given that millions of Americans rely on one of these Medicare plans for their insurance,” said Dr. Bradley, who is also the Deputy Director of the University of Colorado Cancer Center.
Study Details
The researchers used a retrospective cohort from the linked Colorado All Payer Claims Database and Colorado Central Cancer Registry to compare the use of cancer-directed drugs between Medicare Advantage and traditional Medicare patients diagnosed with either cancer type.
They focused on adults aged 65 years and older diagnosed with colorectal cancer or NSCLC and analyzed the records of nearly 4,000 patients. They then estimated the likelihood that patients would receive any cancer drug or a high-cost cancer drug, adjusting for patient characteristics (eg, age, health status) and ecologic characteristics (eg, geographic location, market factors) to make sure the comparison between groups was fair and accounted for these influences.
The research showed patients with local or regional colorectal cancer who were insured by Medicare Advantage were 6 percentage points less likely to receive a cancer drug compared to similar patients insured by traditional Medicare—meaning that Medicare Advantage patients were less likely to be treated with a cancer drug. Patients who did not receive a cancer drug may have had surgery alone or opted for palliative care.
Patients with distant NSCLC who were insured by Medicare Advantage were 10 percentage points less likely to receive a cancer drug compared to those insured by traditional Medicare.
The research showed among patients who did receive a cancer drug, those insured by Medicare Advantage were less likely to receive high-cost drugs for colorectal cancer—10 percentage points less likely for local or regional colorectal cancer, and 9 percentage points less likely for distant colorectal cancer.
However, for patients with NSCLC, the study noted that few low-cost treatment options exist, so even though Medicare Advantage patients were less likely to receive a cancer drug, when cancer drugs were prescribed, they were as likely to be a high-cost therapy.
“We hope this research can help determine whether the cost-control strategies used in Medicare Advantage effectively reduce the use of high-cost drugs,” said Dr. Bradley. “The policy significance is Medicare Advantage appears to control cost of drug prescribing but only to a modest extent. Future studies are needed to determine if health outcomes are similar between the two plans. For more extensive cost controls, lower drug prices are needed.”
The researchers plan to extend this study, look at other databases, and compare the differences between cities and rural areas.
Dr. Bradley is the corresponding author for the JAMA Health Forum article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
