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Boyd AM, Sue C, Khandoobhai A, Vinson B, Shaikh H, Sorenson S, Patel V, Snyder B, Bondarenka C, Koukounas Y, Earl M, Jenkins M. Evaluation of oncology infusion pharmacy practices: A nationwide survey. J Oncol Pharm Pract 2024; 30:127-141. [PMID: 37122190 DOI: 10.1177/10781552231170358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Oncology care continues to evolve at a rapid pace including provision of infusion-based care. There is currently a lack of robust metrics around oncology infusion centers and pharmacy practice. The workgroup completed a nationwide survey to learn about oncology-based infusion pharmacy services offered. The objective was to highlight consistent, measureable oncology-based infusion pharmacy metrics that will provide a foundation to describe overall productivity including emphasis on high patient-safety standards. METHODS A nationwide survey was developed via a workgroup within the Vizient Pharmacy Cancer Care Group beginning in April 2019 and conducted electronically via the Vizient Pharmacy Network from September to November 2020. The survey was designed to capture a number of key metrics related to oncology-based infusion pharmacy services. RESULTS Forty-one sites responded to the survey. Responses highlighted hours of operation (median = 11.5), number of infusion chairs (median = 45). Staffing metrics included 7.1 pharmacist full-time equivalent (FTE) and 7.6 technician FTE per week. 80.5% of sites had cleanrooms and 95.1% reported both hazardous and nonhazardous compounding hoods. 68.3% of sites reported using intravenous (IV) technology, 50.0% measured turnaround time, and 31.4% prepared treatment medications in advance. CONCLUSION There was variability among oncology infusion pharmacy practices in regard to survey responses among sites. The survey results highlight the need for standardization of established productivity metrics across oncology infusion pharmacies in order to improve efficiency and contain costs in the changing oncology landscape. The survey provides insight into oncology infusion pharmacy practices nationwide and provides information for pharmacy leaders to help guide their practices.
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Affiliation(s)
- A M Boyd
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - C Sue
- Department of Pharmacy, UC Health, Cincinnati, OH, USA
| | - A Khandoobhai
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - B Vinson
- Department of Pharmacy, Cedars-Sinai, Los Angeles, CA, USA
| | - H Shaikh
- Department of Pharmacy, University Health, Kansas City, MO, USA
| | - S Sorenson
- Department of Pharmacy, University of Iowa Health Care, Iowa City, IA, USA
| | - V Patel
- Department of Pharmacy, Cedars-Sinai, Los Angeles, CA, USA
| | - B Snyder
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
- Bristol-Meyers Squibb Company, New York, NY, USA
| | - C Bondarenka
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Y Koukounas
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
- Novartis, Basel, Switzerland
| | - M Earl
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
- Seagen, Bothell, WA, USA
| | - M Jenkins
- Department of Pharmacy Services, UVA Health, Charlottesville, VA, USA
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Bekelman JE, Gupta A, Fishman E, Debono D, Fisch MJ, Liu Y, Sylwestrzak G, Barron J, Navathe AS. Association Between a National Insurer's Pay-for-Performance Program for Oncology and Changes in Prescribing of Evidence-Based Cancer Drugs and Spending. J Clin Oncol 2020; 38:4055-4063. [PMID: 33021865 DOI: 10.1200/jco.20.00890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer drug prescribing by medical oncologists accounts for the greatest variation in practice and the largest portion of spending on cancer care. We evaluated the association between a national commercial insurer's ongoing pay-for-performance (P4P) program for oncology and changes in the prescribing of evidence-based cancer drugs and spending. METHODS We conducted an observational difference-in-differences study using administrative claims data covering 6.7% of US adults. We leveraged the geographically staggered, time-varying rollout of the P4P program to simulate a stepped-wedge study design. We included patients age 18 years or older with breast, colon, or lung cancer who were prescribed cancer drug regimens by 1,867 participating oncologists between 2013 and 2017. The exposure was a time-varying dichotomous variable equal to 1 for patients who were prescribed a cancer drug regimen after the P4P program was offered. The primary outcome was whether a patient's drug regimen was a program-endorsed, evidence-based regimen. We also evaluated spending over a 6-month episode period. RESULTS The P4P program was associated with an increase in evidence-based regimen prescribing from 57.1% of patients in the preintervention period to 62.2% in the intervention period, for a difference of +5.1 percentage point (95% CI, 3.0 percentage points to 7.2 percentage points; P < .001). The P4P program was also associated with a differential $3,339 (95% CI, $1,121 to $5,557; P = .003) increase in cancer drug spending and a differential $253 (95% CI, $100 to $406; P = .001) increase in patient out-of-pocket spending, but no significant changes in total health care spending ($2,772; 95% CI, -$181 to $5,725; P = .07) over the 6-month episode period. CONCLUSION P4P programs may be effective in increasing evidence-based cancer drug prescribing, but may not yield cost savings.
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Affiliation(s)
- Justin E Bekelman
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Penn Center for Cancer Care Innovation at the Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.,Healthcare Transformation Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Atul Gupta
- Penn Center for Cancer Care Innovation at the Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.,Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA
| | - Ezra Fishman
- National Committee for Quality Assurance, Washington, DC
| | | | - Michael J Fisch
- AIM Specialty Health, Chicago, IL.,The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Amol S Navathe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Penn Center for Cancer Care Innovation at the Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.,Healthcare Transformation Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Blackmer J, Amoline K, Amancher J, Vogan E, Zimmer H, Borton M, Earl M, Boyd A. Leveraging advanced preparation of oncology medications: Decreasing turnaround-times in an outpatient infusion center. J Oncol Pharm Pract 2020; 27:1454-1460. [PMID: 32970518 DOI: 10.1177/1078155220960222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Many oncology infusions are provided in hospital-based infusion centers. With hospital-based infusion centers seeing increased volumes, patient wait times continue to be a priority. Extended wait times for oncology infusions have been shown to lead to patient dissatisfaction. METHODS Advanced Preparation of oncology infusion medications allows pharmacy to verify and prepare specific medications the day before a patient's infusion appointment. Our study targeted lower cost, commonly used medications to prepare in advance. Data analyzed included turnaround time (TAT), medication waste, and oncology infusion preparation volumes. Implementation took place in two phases to allow time for the healthcare team to adjust to the new workflow. Phase I medications include a small amount of medications prepared manually by pharmacy technicians. Phase II medications included all phase I medications plus additional medications that were compounded in the intravenous (IV) robotic compounding system. RESULTS Our study demonstrated significant decrease in median TAT for medications prepared in advance. 537 infusions were prepared using the Advanced Preparation module with a median TAT of 24.2 minutes (IQR, 18.0-34.0). The pre-implementation median TAT was 45.0 minutes (IQR, 36.0-56.0), which represents a decrease of 20.8 minutes (46.2%) following implementation of the program, (p<0.001). There were a total of 149 advanced preparation doses that were wasted (21.7% of doses). CONCLUSION We have seen a statistically significant reduction in TAT for Advanced Preparation medications. Low volume of Advanced Preparation medications compared to total infusion volume limited impact on overall TAT.
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Yasaitis L, Gupta A, Newcomb C, Kim E, Newcomer L, Bekelman J. An Insurer's Program To Incentivize Generic Oncology Drugs Did Not Alter Treatment Patterns Or Spending On Care. Health Aff (Millwood) 2020; 38:812-819. [PMID: 31059365 DOI: 10.1377/hlthaff.2018.05083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The high and rising costs of anticancer drugs have received national attention. The prices of brand-name anticancer drugs often dwarf those of established generic drugs with similar efficacy. In 2007-16 UnitedHealthcare sought to encourage the use of several common low-cost generic anticancer drugs by offering providers a voluntary incentivized fee schedule with substantially higher generic drug payments (and profit margins), thereby increasing financial equivalence for providers in the choice between generic and brand-name drugs and regimens. We evaluated how this voluntary payment intervention affected treatment patterns and health care spending among enrollees with breast, lung, or colorectal cancer. We found that the incentivized fee schedule had neither significant nor meaningful effects on the use of incentivized generic drugs or on spending. Practices that adopted the incentivized fee schedule already had higher rates of generic anticancer drug use before switching, which demonstrates selection bias in take-up. Our study provides cautionary evidence of the limitations of voluntary payment reform initiatives in meaningfully affecting health care practice and spending.
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Affiliation(s)
- Laura Yasaitis
- Laura Yasaitis is a fellow of the Penn Center for Cancer Care Innovation at the Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, in Philadelphia
| | - Atul Gupta
- Atul Gupta is an assistant professor in the Department of Health Care Management at the Wharton School, University of Pennsylvania
| | - Craig Newcomb
- Craig Newcomb is a biostatistician in the Center for Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine
| | - Era Kim
- Era Kim is an analyst at UnitedHealthcare and the Institute for Health Informatics, University of Minnesota, in Rochester
| | - Lee Newcomer
- Lee Newcomer is a consultant at Lee N. Newcomer Consulting, in Wayzata, Minnesota
| | - Justin Bekelman
- Justin Bekelman ( ) is an associate professor and director of the Penn Center for Cancer Care Innovation at the Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine
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5
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Fishman E, Fisch MJ, Liu Y, Barron JJ, Nguyen A, Sylwestrzak G. Use of Optimal Evidence-Based Anticancer Drug Regimens in Physician Offices Versus Hospital Outpatient Facilities. JCO Oncol Pract 2020; 16:e797-e806. [DOI: 10.1200/jop.19.00525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Cancer care has increasingly shifted from physician offices (MDOs) to hospital-based outpatient departments (HOPDs). This study compared the proportion of patients receiving optimal, evidence-based anticancer drug regimens and the cost of care when administered in these sites. METHODS: Patients with breast, lung, or colorectal cancer were identified from a large health insurance database. Anticancer drug regimens were considered on pathway when they were on the payer’s program list of optimal regimens when administered. Anticancer drug–related costs included all patient- and plan-paid costs on claims for anticancer drugs over the 6-month postindex period; total per-patient costs were summed over all claims in that period. RESULTS: A total of 38,140 patients (MDO, n = 18,998; HOPD, n = 19,142) were included. On-pathway status was similar in HOPDs (59.5%; 95% CI, 58.6% to 60.4%) versus MDOs (60.8%; 95% CI, 59.8% to 61.8%; P = .069). HOPDs had substantially higher costs. Adjusted cancer drug–related costs were $63,763 (95% CI, $62,301 to $65,224) for HOPDs versus $36,500 (95% CI, $35,729 to $37,271) for MDOs ( P < .001); adjusted total costs were $115,843 (95% CI, $113,642 to $118,044) for HOPDs versus $77,346 (95% CI, $76,072 to $78,620) for MDOs ( P < .001). For Medicare Advantage, adjusted total costs were $61,812 for HOPDs compared with $62,769 for MDOs; adjusted drug-related costs were $31,610 for HOPDs compared with $33,168 for MDOs. For commercial insurance, total costs were $119,288 for HOPDs compared with $77,613 for MDOs; drug-related costs were $65,930 for HOPDs compared with $36,366 for MDOs. CONCLUSION: Total and cancer drug–related per-patient costs were higher in HOPDs versus MDOs, but on-pathway status was similar. The cost differential between HOPDs and MDOs was driven by commercially insured members rather than Medicare Advantage members.
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Affiliation(s)
- Ezra Fishman
- National Committee for Quality Assurance, Washington, DC
| | - Michael J. Fisch
- AIM Specialty Health, Chicago, IL
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ying Liu
- National Committee for Quality Assurance, Washington, DC
| | - John J. Barron
- National Committee for Quality Assurance, Washington, DC
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6
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Eaglehouse YL, Georg MW, Richard P, Shriver CD, Zhu K. Costs for Colon Cancer Treatment Comparing Benefit Types and Care Sources in the US Military Health System. Mil Med 2020; 184:e847-e855. [PMID: 30941433 DOI: 10.1093/milmed/usz065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/13/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Cancer is one of the leading causes of morbidity and mortality in the USA, contributing largely to US healthcare spending. Provision of services (direct or purchased) and insurance benefit type may impact cost for cancer care. As a common cause of cancer in both men and women, we aim to compare colon cancer treatment costs between insurance benefit types and care sources in the US Military Health System (MHS) to better understand whether and to what extent these system factors impact cancer care costs. MATERIALS AND METHODS Department of Defense Central Cancer Registry records and MHS Data Repository administrative claims were used to identify MHS beneficiaries aged 18-64 who were diagnosed with primary colon adenocarcinoma and received treatment between 2003 and 2008. The data linkage was approved by the Institutional Review Boards of the Walter Reed National Military Medical Center, the Defense Health Agency, and the National Institutes of Health. Costs to the MHS for each claim related to cancer treatment were extracted from the linked data and adjusted to 2008 USD. We used quantile regression models to compare median cancer treatment costs between benefit types and care sources (direct, purchased, or both), adjusted for demographic, tumor, and treatment characteristics. RESULTS The median per capita (n = 801) costs for colon cancer care were $60,321 (interquartile range $24,625, $159,729) over a median follow-up of 1.7 years. The model-estimated treatment costs were similar between benefit types. Patients using direct care had significantly lower estimated median costs [$34,145 (standard error $4,326)] than patients using purchased care [$106,395 ($10,559)] or both care sources [$82,439 ($13,330)], controlled for patient demographic, tumor, and treatment characteristics. Differences in cost by care source were noted for patients with later stage tumors and by treatment type. Relative costs were 2-3 times higher for purchased care compared to direct care for patients with late-stage tumors and for patients receiving chemotherapy or radiation treatment. CONCLUSIONS In the MHS, median cost for colon cancer treatment was lower in direct care compared to purchased care or patients using a combination of direct and purchased care. The variation in cancer treatment costs between care sources may be due to differences in treatment incentives or capabilities. Additional studies on cost differences between direct and purchased services are needed to understand how provision of care affects cancer treatment costs and to identify possible targets for cost reduction.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852.,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Matthew W Georg
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852.,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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7
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Parsons HM, Schmidt S, Tenner LL, Davidoff AJ. Trends in Antineoplastic Receipt after Medicare Payment Reform: Implications for Future Oncology Payment Design. J Cancer Policy 2018; 17:51-58. [PMID: 30345223 DOI: 10.1016/j.jcpo.2016.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The Medicare Modernization Act (MMA) reduced reimbursement for many antineoplastics delivered in outpatient settings, altering practice patterns for some cancers. To further evaluate the MMA's effect, we focus on colon cancer, where longstanding fluorouracil-based regimens were augmented in 2004 with 3 newly-approved drugs (oxaliplatin, bevacizumab, and/or cetuximab). Staggered implementation of MMA reimbursement changes (physician offices implemented reimbursement changes in 2005 vs hospital outpatient departments(OPD) in 2006) provide a natural experiment to examine policy effects. Methods Using the 2000-2009 SEER-Medicare data, we examined antineoplastic use among 59,642 stage II-IV colon cancer patients. Using multivariate logistic regression models, we conducted difference-in-differences analyses to examine an interaction between time (pre-post MMA) and setting (physician offices versus OPDs) on antineoplastic receipt, adjusting for patient and cancer characteristics. A significant interaction indicates different practice patterns in physician offices versus OPD during the staggered implementation. Results After the reimbursement change in 2007-09 relative to 2000-03, use of fluorouracil-based therapy decreased slightly (Marginal Probability(MP): -0.07 stage II; -0.05 stage III; -0.05 stage IV; p< 0.01), while use of new drugs increased substantially (MP: 0.48 stage II; 0.69 stage III, 0.79 stage IV; p< 0.01). The interaction between MMA implementation and physician office setting was significant when examining use of new agents for Stage IV disease only. Conclusions Our results indicate that providers responded to reimbursement changes after the MMA by increasing use of newly approved agents, but the magnitude of the response was small and limited to individuals diagnosed with Stage IV disease.
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Affiliation(s)
- Helen M Parsons
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center
| | - Susanne Schmidt
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center
| | - Laura L Tenner
- Department of Medicine, University of Texas Health Science Center
| | - Amy J Davidoff
- Department of Health Policy and Management, Yale University School of Public Health
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8
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Eaglehouse YL, Manjelievskaia J, Shao S, Brown D, Hofmann K, Richard P, Shriver CD, Zhu K. Costs for Breast Cancer Care in the Military Health System: An Analysis by Benefit Type and Care Source. Mil Med 2018; 183:e500-e508. [DOI: 10.1093/milmed/usy052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Yvonne L Eaglehouse
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Janna Manjelievskaia
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
| | - Stephanie Shao
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
| | - Derek Brown
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
| | - Keith Hofmann
- Kennell and Associates, Inc., 3130 Fairview Park Drive, Suite 450, Falls Church, VA
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Craig D Shriver
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
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Adams AS, Madden JM, Zhang F, Lu CY, Ross-Degnan D, Lee A, Soumerai SB, Gilden D, Chawla N, Griggs JJ. Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1345-1354. [PMID: 29241894 PMCID: PMC5734096 DOI: 10.1016/j.jval.2017.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/19/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer. METHODS We leveraged a representative 5% national sample of all fee-for-service dual enrollees in the United States (2004-2007) to evaluate the impact of the removal of caps on the number of reimbursable prescriptions per month (drug caps) under Part D on 1) prevalence and 2) average days' supply dispensed for antidepressants, antihypertensives, and lipid-lowering agents overall and by race (white and black). RESULTS The removal of drug caps was associated with increased use of lipid-lowering medications (days' supply 3.63; 95% confidence interval [CI] 1.57-5.70). Among blacks in capped states, we observed increased use of lipid-lowering therapy (any use 0.08 percentage points; 95% CI 0.05-0.10; and days' supply 4.01; 95% CI 2.92-5.09) and antidepressants (days' supply 2.20; 95% CI 0.61-3.78) and increasing trends in antihypertensive use (any use 0.01 percentage points; 95% CI 0.004-0.01; and days' supply 1.83; 95% CI 1.25-2.41). The white-black gap in the use of lipid-lowering medications was immediately reduced (-0.09 percentage points; 95% CI -0.15 to -0.04). We also observed a reversal in trends toward widening white-black differences in antihypertensive use (level -0.08 percentage points; 95% CI -0.12 to -0.05; and trend -0.01 percentage points; 95% CI -0.02 to -0.01) and antidepressant use (-0.004 percentage points; 95% CI -0.01 to -0.0004). CONCLUSIONS Our findings suggest that the removal of drug caps under Part D had a modest impact on the treatment of hypercholesterolemia overall and may have reduced white-black gaps in the use of lipid-lowering and antidepressant therapies.
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Affiliation(s)
- Alyce S Adams
- Kaiser Permanente Division of Research, Oakland, CA, USA.
| | - Jeanne M Madden
- School of Pharmacy, Northeastern University, Boston, MA, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Dan Gilden
- Jen Associates, Inc., Cambridge, MA, USA
| | - Neetu Chawla
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Jennifer J Griggs
- Departments of Internal Medicine, Hematology/Oncology, and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
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10
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Gordan L, Grogg A, Blazer M, Fortner B. Unintended Consequences in Cancer Care Delivery Created by the Medicare Part B Proposal: Is the Clinical Rationale for the Experiment Flawed? J Oncol Pract 2016; 13:e139-e151. [PMID: 28029298 DOI: 10.1200/jop.2016.016550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Medicare currently enrolls ≥ 45 million adults, and by 2030 this is projected to increase to ≥ 80 million beneficiaries. With this growth, the Centers for Medicare & Medicaid Services (CMS) issued a proposal, the Medicare Part B Drug Payment Model, to shrink drug expenditures, a major contributor to overall health care costs. For this to not adversely affect patient outcomes, lower-cost alternative medications with equivalent efficacy and no increased toxicity must be available. This is often not true in the treatment of cancer. Herein, we examine the flaws in the rationale of the CMS and the potential unintended consequences of this experiment. METHODS We identified the top three oncology expenditures (rituximab, bevacizumab, and trastuzumab) and their vetted alternatives (per the National Comprehensive Cancer Network guidelines) to ascertain whether lower-cost equivalent alternatives are available. Drug cost was based on April 2016 average sale price. We explored both efficacy of the agents and, when applicable, toxicity to compare alternatives to these high-dollar medications. RESULTS For the largest Medicare oncology drug expenditures, there is not a lower-cost option with equal efficacy for their primary indications. Without lower-cost alternatives, the unintended consequence of this CMS experiment may include curtailing access to care or an increase in patient/program costs. CONCLUSION The CMS proposal, by simply lowering reimbursement for drugs, does not acknowledge the value of these agents and could unintentionally reduce quality of care. Alternative approaches to value-based care, such as the Oncology Care Model and similar frameworks, should be explored.
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Affiliation(s)
- Lucio Gordan
- Florida Cancer Specialists and Research Institute, Gainesville; Xcenda of AmerisourceBergen, Palm Harbor, FL; AmerisourceBergen Specialty Group, Frisco, TX; and Oncology Supply of AmerisourceBergen, Dothan, AL
| | - Amy Grogg
- Florida Cancer Specialists and Research Institute, Gainesville; Xcenda of AmerisourceBergen, Palm Harbor, FL; AmerisourceBergen Specialty Group, Frisco, TX; and Oncology Supply of AmerisourceBergen, Dothan, AL
| | - Marlo Blazer
- Florida Cancer Specialists and Research Institute, Gainesville; Xcenda of AmerisourceBergen, Palm Harbor, FL; AmerisourceBergen Specialty Group, Frisco, TX; and Oncology Supply of AmerisourceBergen, Dothan, AL
| | - Barry Fortner
- Florida Cancer Specialists and Research Institute, Gainesville; Xcenda of AmerisourceBergen, Palm Harbor, FL; AmerisourceBergen Specialty Group, Frisco, TX; and Oncology Supply of AmerisourceBergen, Dothan, AL
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11
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Altomare I, Irwin B, Zafar SY, Houck K, Maloney B, Greenup R, Peppercorn J. Physician Experience and Attitudes Toward Addressing the Cost of Cancer Care. J Oncol Pract 2016; 12:e281-8, 247-8. [PMID: 26883407 DOI: 10.1200/jop.2015.007401] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We surveyed US cancer doctors to examine current attitudes toward cost discussions and how they influence decision making and practice management. METHODS We conducted a self-administered, anonymous, electronic survey of randomly selected physician ASCO members to evaluate the frequency and nature of cost discussions reported by physicians, attitudes toward discussions of cost in clinics, and potential barriers. RESULTS A total of 333 of 2,290 physicians responded (response rate [RR], 15%; adjusted RR after omitting nonpracticing physician ASCO members, 25%), Respondent practice settings were 45% academic and 55% community/private practice. Overall, 60% reported addressing costs frequently/always in clinic, whereas 40% addressed costs rarely/never. The largest reported barrier was lack of resources to guide discussions. Those who reported frequent discussions were significantly more likely to prioritize treatments in terms of cost and believed doctors should explain patient and societal costs. A total of 36%did not believe that doctors should discuss costs with patients. Academic practitioners were significantly less likely to discuss costs (odds ratio [OR], 0.41; P = .001) and felt less prepared for such discussions (OR, 0.492; P = .005) but were more likely to consider costs to the patient (OR, 2.68; P = .02) and society (OR, 1.822; P = .02). CONCLUSION Although the majority of respondents believe it is important to consider out-of-pocket costs to patients, a substantial proportion do not discuss or consider costs of cancer care. Lack of consensus on the importance of such discussions and uncertainty regarding the optimal timing and content appear to be barriers to addressing costs of care with patients.
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Affiliation(s)
- Ivy Altomare
- Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - Blair Irwin
- Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - Syed Yousuf Zafar
- Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - Kevin Houck
- Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - Bailey Maloney
- Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - Rachel Greenup
- Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - Jeffrey Peppercorn
- Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
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Schnipper LE, Meropol NJ. Payment for Cancer Care: Time for a New Prescription. J Clin Oncol 2014; 32:4027-8. [DOI: 10.1200/jco.2014.57.9573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Neal J. Meropol
- University Hospitals Case Medical Center Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
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