Authors: Chou YT, Farley JF, Stinchcombe TE, Proctor AE, Lafata JE, Dusetzina SB
Title: The Association Between Medicare Low-income Subsidy and Anticancer Treatment Uptake in Advanced Lung Cancer.
Journal: J Natl Cancer Inst :-
Date: 2019 Sep 10
PubMed ID: 31501872
Abstract: BACKGROUND: High out-of-pocket costs may impact anticancer treatment uptake. Low-income subsidies (LIS) can reduce patient out-of-pocket cost for Medicare Part D-covered treatments. We examined whether LIS increased uptake and reduced time to initiate orally-administered anticancer drugs in patients with advanced non-small cell lung cancer (NSCLC). METHODS: Using SEER-Medicare data, we identified older adults (aged 65+) diagnosed with advanced NSCLC from 2007-2013 and categorized them as full, partial, or non-LIS. We used propensity-score weighted (IPTW) Cox proportional hazards regression to assess the likelihood of and time to initiate Part D treatments. Part B medication uptake was our negative control since supplemental insurance reduces out-of-pocket costs for those drugs. All statistical tests were two-sided. RESULTS: Among 19,746 advanced NSCLC patients, approximately 10% initiated Part D treatments. Patients with partial or no subsidies were less likely to initiate Part D treatments than those with full subsidies (Partial LIS vs. Full LIS: HRIPTW=0.77, 95%CI=0.62-0.97; Non-LIS vs. Full LIS: HRIPTW=0.87, 95%CI=0.79-0.95). Time to initiate Part D treatments was also slightly shorter among full-LIS patients [Full LIS mean=10.8 months (SD = 0.04), Partial LIS:mean =11.3 months (SD = 0.08), Non-LIS mean=11.1 months (SD = 0.03), p<.001]. Conversely, patients with partial or no subsidies had shorter time to initiation of Part B drugs. CONCLUSION: Patients receiving full low-income subsidies had higher orally-administered anticancer treatment uptake than patients without subsidies. Notably, patients with partial subsidies had the lowest treatment uptake, likely due to their low incomes combined with high expected out-of-pocket spending. High out-of-pocket costs for Part D medications may be a barrier to treatment use for patients without full low-income subsidy.