In a study reported in JCO Oncology Practice, Li et al identified elements of increasing financial burden associated with the use of high-cost targeted oral anticancer drugs among Medicare patients between 2011 and 2016.
The study used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare 5% Cancer File to identify 2,192 patients aged ≥ 65 years with one primary cancer diagnosis between 2011 and 2016 who received higher-cost targeted oral anticancer drugs. Early-generation, lower-cost agents—such as tamoxifen, anastrozole, letrozole, and exemestane—were not included in the analysis. Eligible patients were enrolled in a Part D plan for the entire year and did not receive a low-income subsidy at any time across the study years.
Key Findings
Between 2011 and 2016, use of high-cost targeted oral drugs increased from 3.6% to 8.9% among patients receiving systemic therapy. The proportion of nonsubsidized patients receiving targeted oral drugs who reached catastrophic coverage increased from 54.6% to 60.3% between 2011 and 2016. The highest percentages of patients reaching the catastrophic coverage phase across the study period were those with multiple myeloma (80%), thyroid cancer (73.3%), pancreatic cancer (72.7%), kidney cancer (66.7%), colorectal cancer (65.4%), leukemia (63.8%), breast cancer (59.7%), prostate cancer (59.6%), lymphoma (58.7%), and lung cancer (20.6%). Overall, 59.7% of patients reaching the catastrophic coverage phase did so in the same month of target oral drug initiation, with 16.2% reaching it in the following month.
Between 2011 and 2016, among patients reaching the catastrophic coverage phase, mean total gross spending on targeted oral drugs in the catastrophic phase increased from $16,074 to $64,233, and mean patient out-of-pocket spending increased from $596 to $2,549. Mean 30-day total spending increased from $4,011 to $8,857 and mean 30-day out-of-pocket spending increased from $154 to $328.
The investigators concluded, “The high and growing burden from targeted oral anticancer medications highlighted the need for reining in drug prices and capping out-of-pocket spending.”
Meng Li, ScM, PhD, of Health Services Research, The University of Texas MD Anderson Cancer Center, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported in part by the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
