The significant out-of-pocket costs cancer patients face before Medicare Insurance drug benefits kick in may delay initiation of tyrosine-kinase inhibitor (TKI) therapy for chronic myeloid leukemia (CML), according to a study published in the Journal of Clinical Oncology.
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The way Medicare Part D is structured requires patients to pay at least $4840 out-of-pocket in a year before coverage begins. Then, they pay 5% of the monthly drug cost. However, while this model works well for some, others can be forced to pay exorbitant prices depending on the drug they need. And while patients can apply for subsidies to lower their drug costs, less than half qualify. These factors could affect how patients adhere to treatment plans.
Using SEER-Medicare data, researchers led by Stacie Dusetzina, PhD, University of North Carolina (Chapel Hill, NC), examined rates of initiation and adherence to TKIs among Medicare beneficiaries with CML with and without cost-sharing subsidies.
They found that among 393 patients diagnosed with CML from 2007 to 2011, 68% initiated TKI treatment within 180 days after diagnosis, meaning nearly a third of patients started TKI treatment late. Additionally, statistical analyses revealed that patients with cost-sharing subsidies, younger age, lower comorbidity, and later year of diagnosis were significantly more likely to initiate TKIs within a 6-month period. Further, 61% of patients were adherent, with patients 80 years or older more likely to not adhere than those aged 66 to 69 years.
From these results, researchers concluded that many Medicare beneficiaries with CML are delaying TKI initiation. The fact that these patients are often without cost-sharing subsidies suggests that out-of-pocket costs may be a barrier to timely initiation of therapy.
"Once you're on Medicare Part D, there really aren't ways to minimize these out-of-pocket costs, other than subsidies," said Dr Dusetzina. “We really need to think carefully about how much these high out-of-pocket costs are impacting patients' access to life-saving drugs."
