Cost May Drive Medicare Patients to Delay or Forego Treatment for Blood Cancer, Report Suggests

A new research report from Milliman, commissioned by the Leukemia and Lymphoma Society (LLS), found that fewer than half of patients with blood cancer received treatment within 3 months of diagnosis, and LLS says that costs may be keeping patients from getting care.

The report used CMS data and Medicare Advantage (MA) data to identify patients with newly diagnosed blood cancers, including acute leukemia, chronic leukemia, lymphoma, multiple myeloma, and bone marrow disorders. The researchers identified 35,877 patients who were fee-for-service (FFS) Medicare beneficiaries, and 1898 who had MA plans with Part D coverage (MAPD).

The data showed that, for patients newly diagnosed with blood cancer, only 45% of the MAPD population and 41% of the FFS population received active treatment for their blood cancer within 90 days of their diagnosis. The lowest rates of active treatment were among patients with bone marrow disorders (15% in MAPD and 19% in FFS), while rates were higher among those with multiple myeloma (58% in MAPD and 59% in FFS).

A key driver of spending in blood cancer is anticancer therapy; anticancer products were responsible for 53% ($72,692) of FFS and 55% ($64,968) of MAPD average allowed spending in the first year after diagnosis, and spending in Part B was significantly higher than in Part D in the first year, at $53,524 versus $19,167 (FFS) and $49,375 versus $15,593 (MAPD) average allowed spending.

Those costs also drove high out-of-pocket (OOP) responsibilities for patients; among those patients who did receive active treatment for their cancer, average OOP costs for years 1 and 2 were $17,084 and $8,295, respectively, for FFS patients and $6,896 and $2,603, respectively, for MAPD patients. Some patients had even higher costs; at the 90th percentile for patients with chronic leukemia, FFS patients had average OOP costs of $14,899 in Part B and $10,076 in Part D, and MAPD patients had average OOP costs of $8,942 in Part B and $2,652 in Part D.

Compounding the problem of high OOP spending for FFS beneficiaries is the fact that supplemental insurance, Medigap, can be refused in most states to patients with pre-existing conditions, including cancer.

Taken together, says the LLS, these findings suggest that cost may be a key factor in patients’ decisions to delay or even forego care.

“In addition to the emotional impact of dealing with a blood cancer, patients and families often face extraordinary costs in the first year after diagnosis and beyond,” says Louis J. DeGennaro, PhD, president and chief executive officer of LLS. “The Leukemia and Lymphoma Society hopes that the findings from this new study will prompt payers, providers, patient advocates and policymakers to work together to address the financial burdens for patients.”

LLS urges patients to consider their options closely during the Medicare open enrollment period, which closes on December 7. If enrollees have or expect to have high costs, they may benefit from an MA plan with options that feature OOP caps.