High Cost Sharing Associated With Lower Rates of Cancer Treatment Initiation, Study Finds

Advances in research have led to increased therapeutic options for patients with cancer, but these drugs come at a substantial cost; high out-of-pocket costs pose a significant barrier to treatment initiation for patients with cancer, according to a new, retrospective claims-based study published in Cancer Medicine.

Pengxiang Li, PhD, and colleagues compared initiation of cancer treatment in elderly Medicare Part D enrollees with low out-of-pocket costs due to full low-income subsidies (LIS) with enrollees who were not LIS beneficiaries and were, therefore, responsible for cost sharing of more than 25% during Medicare’s initial coverage phase. This comparison was designed to assess how out-of-pocket costs contribute to treatment initiation with targeted therapy within 6 months of a cancer diagnosis.

Using Medicare claims data from 2011 to 2013, the researchers focused their study on initiation of treatment for renal cell carcinoma, a disease for which there are 10 FDA-approved therapies, 7 of which are oral agents (sorafenib, sunitinib, everolimus, pazopanib, axitinib, cabozantinib, and lenvatinib) and 3 of which are infused drugs (temsirolimus, bevacizumab, and nivolumab). Six of the agents are covered under Part D, and 4 are covered under part B.

Cost-sharing requirements for Part D treatments that are included on a specialty pharmacy tier typically require non-LIS enrollees to pay 25% to 33% coinsurance during each year until a patient enters the coverage gap. After entering the coverage gap, the patient is responsible for even higher cost sharing until he or she reaches the catastrophic coverage threshold, under which a 5% coinsurance applies for the remainder of the year. In contrast, LIS enrollees are responsible for cost sharing of $6.60 or less per month.

A total of 1721 patients were considered in the analysis. Given mean total costs of approximately $7200 per 30-day prescription for therapies covered under Part D, non-LIS patients’ first prescriptions pushed beneficiaries into the coverage gap and generated out-of-pocket costs of $2800 or greater. LIS beneficiaries, as noted above, had out-of-pocket costs that remained at $6.60 or under.

A lower percentage of the non-LIS patient group (20.7%) initiated therapies covered under Part D compared to the LIS beneficiary group (33.9%) in the 6 months after diagnosis, while initiation rates for therapies covered under Part B were similar (8.2% and 10.2%, respectively) between the 2 groups.

“The association between high cost sharing and reduced rates of treatment initiation was apparent despite controlling for demographic and clinical characteristics that might influence treatment decisions and was confirmed via several sensitivity analyses,” wrote the authors.

The authors also reported that non-LIS patients had significantly lower rates of initiating any targeted therapies than LIS beneficiaries, even in cases in which their therapies were available through the Part B benefit (and therefore subject to lower cost sharing).

The authors noted that these findings have clinical and policy implications. First, in reviewing treatment options with patients, clinicians should have proactive discussions about financial barriers to treatment initiation and adherence. Second, streamlined processes for accessing copayment assistance is likely to be useful to reduce both the stress and the burden associated with obtaining financial assistance.