Adherence and out‐of‐pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer

Abstract

Background Abiraterone and enzalutamide are high‐cost oral therapies that increasingly are used to treat patients with advanced prostate cancer; these agents carry the potential for significant financial consequences to patients. In the current study, the authors investigated coping and material measures of the financial hardship of these therapies among patients with Medicare Part D coverage. Methods The authors performed a retrospective cohort study on a 20% sample of Medicare Part D enrollees who underwent treatment with abiraterone or enzalutamide between July 2013 and June 2015. The authors described the variability in adherence rates and out‐of‐pocket payments among hospital referral regions in the first 6 months of therapy and determined whether adherence and out‐of‐pocket payments were associated with patient factors and the socioeconomic characteristics of where a patient was treated. Results There were 4153 patients who filled abiraterone or enzalutamide prescriptions through Medicare Part D in 228 hospital referral regions. The mean adherence rate was 75%. The median monthly out‐of‐pocket payment for abiraterone and enzalutamide was $706 (range, $0‐$3505). After multilevel, multivariable adjustment for patient and regional factors, adherence was found to be lower in patients who were older (69% for patients aged ≥85 years vs 76% for patients aged <70 years; P < .01) and in those with low‐income subsidies (69% in those with a subsidy vs 76% in those without a subsidy; P < .01). Both Hispanic ethnicity and living in a hospital referral region with a higher percentage of Hispanic beneficiaries were found to be independently associated with higher out‐of‐pocket payments for abiraterone and enzalutamide. Conclusions There were substantial variations in the adherence rate and out‐of‐pocket payments among Medicare Part D beneficiaries who were prescribed abiraterone and enzalutamide. Sociodemographic patient and regional factors were found to be associated with both adherence and out‐of‐pocket payments.

Out-of-Pocket Cost Burden Associated With Contemporary Management of Advanced Prostate Cancer Among Commercially Insured Patients

“…23 Notably, in a study among Medicare beneficiaries with advanced prostate cancer, Black patients experienced lower OOPC, a finding which was even more pronounced among those with low-income subsidies. 19 Collectively, these data support an individualized approach to addressing financial toxicity that includes consideration of the types of coverage among minority prostate cancer survivors.…”

Coping Mechanisms for Financial Toxicity Among Patients With Metastatic Prostate Cancer: A Survey-based Assessment

“…15-17,22 In contrast, adherence to advanced prostate cancer treatments may be higher compared to other malignancies, 17 with multiple studies showing no association between high out-of-pocket costs and treatment nonadherence and discontinuation. 18,23,24 Our study offers a unique, direct insight into these findings as patients reported rarely partially filling or discontinuing their medications. Instead, patients frequently made personal sacrifices to meet the financial demands of treatment.…”

Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer

“…Although few studies have examined OOP payments for mCRPC treatment, our estimates of OOP payment for anticancer drugs are lower than those of prior studies. 6,8 A key difference between our work and prior is that prior studies have estimated payments among Medicare Part D beneficiaries. For example, a study that estimated the expected mean monthly price per fill for anticancer medications using 2010 and 2019 Medicare Part D benefit design determined that mean monthly OOP payments across 11 oral anticancer medications increased from $8,794 to $10,470.…”

“…5 Furthermore, the extent to which gross payments are passed onto patients in the form of OOP payments is determined by an individual's insurance benefit design. Because most of the research specific to this clinical context has been conducted among older patients enrolled in Medicare Part D, 6 even less is known about payments for these drugs for patients with employer-sponsored health insurance (ESHI). In this article, we evaluate gross and OOP payments for six drugs approved as first-line treatment for mCRPC in patients with ESHI.…”