Study reveals cost differences between Medicare Advantage and traditional Medicare patients in cancer drugs

(Press-News.org) A new study examining the use of high-cost drugs among patients with colorectal cancer and non-small cell lung cancer found those insured through Medicare Advantage received less expensive cancer drugs compared to others on Traditional Medicare.

The findings were published today in JAMA Health Forum.

"Lung cancer is the leading cause of cancer-related deaths in the United States and colorectal cancer ranks third. Gaining a better understanding of treatment options and their costs under different insurance plans is important for assessing the overall healthcare landscape and how insurances manage patient costs,” said the study’s first author Cathy Bradley, PhD, Dean of the Colorado School of Public Health.

The study found Medicare Advantage patients received less expensive cancer drugs, particularly for colorectal cancer, when compared to Traditional Medicare.

But this was not the case for non-small cell lung cancer. The researchers found there are less low-cost treatment alternatives available, resulting in high-cost drugs regardless of insurance.

“We are among the first to explore how cancer treatments differ for patients enrolled in Medicare Advantage compared to Traditional Medicare, which is crucial given that millions of Americans rely on one of these Medicare plans for their insurance,” said Bradley, who is also the Deputy Director of the University of Colorado Cancer Center located on the University of Colorado Anschutz Medical Campus.

The findings, she said, suggest that Medicare Advantage plans, with their cost containment strategies may result in lower treatment costs. At the same time, it could also result in reduced access to certain cancer treatments. The pattern wasn’t as clear for non-small cell lung cancer due to high-cost drugs seen as necessary for survival regardless of insurance type.

The researchers used a retrospective cohort from the linked Colorado All Payer Claims Database (APCD) and Colorado Central Cancer Registry (CCCR) to compare the use of cancer-directed drugs between Medicare Advantage and Traditional Medicare patients diagnosed with either cancer.

They focused on adults aged 65 years and older diagnosed with colorectal or non-small cell lung cancer and analyzed the records of nearly 4,000 patients.

They then estimated the likelihood that patients would receive either any cancer drug or a high-cost cancer drug. They adjusted for factors like patient characteristics (e.g., age, health status) and ecological characteristics (e.g., geographical location, market factors) to make sure the comparison between groups was fair and accounted for these influences.

The research showed patients with local or regional colorectal cancer who were insured by Medicare Advantage were six percentage points less likely to receive a cancer drug compared to similar patients insured by Traditional Medicare. This means that Medicare Advantage patients were less likely to be treated with a cancer drug. Patients who did not receive a cancer drug may have had surgery alone or opted for palliative care.

Patients with distant non-small cell lung cancer who were insured by Medicare Advantage were 10 percentage points less likely to receive a cancer drug compared to those insured by Traditional Medicare.

The research showed among patients who did receive a cancer drug, those insured by Medicare Advantage were less likely to receive high-cost drugs for colorectal cancer, specifically:

10 percentage points less likely for local or regional colorectal cancer Nine percentage points less likely for distant colorectal cancer However, for non-small cell lung cancer, the study notes that few low-cost treatment options exist, so even though Medicare Advantage patients were less likely to receive a cancer drug, when cancer drugs were prescribed, they were as likely to be a high-cost therapy.

“We hope this research can help determine whether the cost-control strategies used in Medicare Advantage effectively reduce the use of high-cost drugs,” said Bradley. “The policy significance is Medicare Advantage appears to control cost of drug prescribing but only to a modest extent. Future studies are needed to determine if health outcomes are similar between the two plans. For more extensive cost controls, lower drug prices are needed.”

The researchers plan to extend this study, look at other databases and compare the differences between cities and rural areas.

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado – which see more than two adult and pediatric patient visits yearly. Innovative, interconnected and highly collaborative, the CU Anschutz Medical Campus delivers life-changing treatments, patient care and professional training and conducts world-renowned research fueled by $910 million in annual research funding, including $757 million in sponsored awards and $153 million in philanthropic gifts. 

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