Impact of Medicare Part D on out-of-pocket drug costs and medical use for patients with cancer

Authors

  • Sheetal M. Kircher MD,

    Corresponding author
    1. Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    • Corresponding author: Sheetal M. Kircher, MD, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 676 N St. Clair, Suite 850, Chicago, IL 60611; Fax: 312-695-6189; skircher@nmff.org

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  • Michael E. Johansen MD,

    1. Department of Family Medicine, Ohio State University, Columbus, Ohio
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  • Halla S. Nimeiri MD,

    1. Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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  • Caroline R. Richardson MD,

    1. Department of Family Medicine, Ann Arbor VA Health System, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan
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  • Matthew M. Davis MD, MAPP

    1. Department of General Pediatrics, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan
    2. Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan
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  • Presented in poster form at the 2013 ASCO Annual Meeting; May 31-June 4, 2013; Chicago, IL; and at the 2013 ASCO Quality Care Symposium; November 1-2, 2013; San Diego, CA.

Abstract

BACKGROUND

Medicare Part D was designed to reduce out-of-pocket (OOP) costs for Medicare beneficiaries, but to the authors' knowledge the extent to which this occurred for patients with cancer has not been measured to date. The objective of the current study was to examine the impact of Medicare Part D eligibility on OOP cost for prescription drugs and use of medical services among patients with cancer.

METHODS

Using the Medical Expenditure Panel Survey (MEPS) for the years 2002 through 2010, a differences-in-differences analysis estimated the effects of Medicare Part D eligibility on OOP pharmaceutical costs and medical use. The authors compared per capita OOP cost and use between Medicare beneficiaries (aged ≥65 years) with cancer to near-elderly patients aged 55 years to 64 years with cancer. Statistical weights were used to generate nationally representative estimates.

RESULTS

A total of 1878 near-elderly and 4729 individuals with Medicare were included (total of 6607 individuals). The mean OOP pharmaceutical cost for Medicare beneficiaries before the enactment of Part D was $1158 (standard error, ±$52) and decreased to $501 (standard error, ±$30), a decline of 43%. Compared with changes in OOP pharmaceutical costs for nonelderly patients with cancer over the same period, the implementation of Medicare Part D was associated with a further reduction of $356 per person. Medicare Part D appeared to have no significant impact on the use of medications, hospitalizations, or emergency department visits, but was associated with a reduction of 1.55 in outpatient visits.

CONCLUSIONS

Medicare D has reduced OOP prescription drug costs and outpatient visits for seniors with cancer beyond trends observed for younger patients, with no major impact on the use of other medical services noted. Cancer 2014;120:3378–3384. © 2014 American Cancer Society.

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