Association of high cost sharing and targeted therapy initiation among elderly Medicare patients with metastatic renal cell carcinoma

In Cancer Medicine, Pengxiang (Alex) Li and colleagues, including Jalpa Doshi, explore whether high out-of-pocket costs limit access to oral therapies for Medicare patients newly diagnosed with metastatic renal cell carcinoma. Using 2011–2013 Medicare claims, the investigators identified 1,721 patients newly diagnosed with metastases in the liver, lung, or bone. They compared low-income Medicare Part D beneficiaries (who had low out-of-pocket costs due to subsidies) to their counterparts who were responsible for more than 25% cost sharing during Medicare's initial coverage phase. They examined targeted therapy initiation rates and time to initiation for (1) oral medications covered under Medicare's prescription drug benefit (Part D); (2) injected or infused medications covered by Medicare's medical benefit (Part B); and (3) any targeted therapy (Part D or Part B).

On average, non-low income patients were responsible for out-of-pocket costs of ≥$2,800 for their initial oral prescription, compared to ≤$6.60 for low-income patients. Compared to low-income patients, non-low income patients were less likely to initiate oral therapies (20.7% vs. 33.9%) and any targeted therapies (26.7% vs. 40.4%), and slower to access therapy. High cost sharing was associated with reduced and/or delayed access to targeted therapies under Medicare Part D, suggesting that financial barriers play a role in treatment decisions.