Study Details and Results
Dr Li and colleagues analyzed a nationally representative 5% sample of the SEER-Medicare database during 2011-2016. The team focused their attention on Medicare Part D beneficiaries who received systemic therapy for a single primary cancer, were 65 years of age or older, were enrolled for an entire year, and did not receive a low-income subsidy.
The researchers also focused on high-cost TOAMs and excluded early-generation oral targeted therapies, such as tamoxifen citrate, anastrozole, letrozole, and exemestane.
Overall, the researchers analyzed data for 2192 person-years. The average patient age was 75.2 years, 58.9% were men, and 83.8% were White. The most common cancer types were prostate cancer (29.2%), leukemia (17.4%), and lung cancer (14.3%).
The data showed that, from 2011 to 2016, the number of cancer patients receiving TOAMs increased nearly 3-fold, from 3.6% to 8.9%.
The percentage of TOAM users who reached the catastrophic coverage level increased from 54.6% in 2011 to 60.3% in 2016. The cancer types with the highest percentages of patients reaching the catastrophic phase were multiple myeloma (80%), thyroid cancer (73.3%), and pancreatic cancer (72.7%).
Overall, 59.7% of patients reached the catastrophic phase within the first month of starting TOAM therapy. The average number of days during which TOAMs were supplied in the catastrophic phase doubled from 2011 to 2016, increasing from 97 days to 201 days.
The mean total gross and out-of-pocket spending on TOAMs quadrupled in the catastrophic phase. The mean total gross spending increased from $16,074 in 2011 to $64,233 in 2016. The mean out-of-pocket spending increased from $596 to $2549.
The rise in the cost of total gross spending on TOAMs (greater than 100%) far outpaced inflation for other prescription drugs (19%) during the same time period.1,6
These data suggest an urgent need to control drug prices, according to Dr Li and colleagues.1 They suggested policy actions, including a cap on out-of-pocket spending for enrollees and allowing the federal government to negotiate prices for high-cost drugs. Both of these policies were included in the Inflation Reduction Act of 2022.2
- Li M, Liao K, Pan I-W, Shih Y-CT. Growing financial burden from high-cost targeted oral anticancer medicines among Medicare beneficiaries with cancer. JCO Oncol Prac. Published online September 13, 2022. doi:10.1200/OP.22.00171
- How will the prescription drug provisions in the Inflation Reduction Act affect medicare beneficiaries? Kaiser Family Foundation, Published August 18, 2022. Accessed September 15, 2022.
- Dusetzina SB. Drug pricing trends for orally administered anticancer medications reimbursed by commercial health plans, 2000-2014. JAMA Oncol. 2016;2(7):960-961. doi:10.1001/jamaoncol.2016.0648
- Shih Y-CT, Xu Y, Liu L, et al. Rising prices of targeted oral anticancer medications and associated financial burden on Medicare beneficiaries. J Clin Oncol. 2017;35(22):2482-2489. doi:10.1200/JCO.2017.72.3742
- Dusetzina SB. Your money or your life—The high cost of cancer drugs under Medicare Part D. N Engl J Med. 2022; 386:2164-2167. doi:10.1056/NEJMp22027726
- An overview of the Medicare Part D prescription drug benefit. Kaiser Family Foundation. Published October 13, 2021. Accessed September 15, 2022.