Access to prescription drug coverage improves myeloma survival

Patients with myeloma with outpatient prescription drug coverage were more likely to receive oral targeted agents instead of parenteral chemotherapy, thereby increasing their chances of survival, according to a study of Medicare Part D enrollees published in Journal of Clinical Oncology.

Adjustments to coverage policies allowed for patient access to optimal treatments, according to the researchers.

“Our study demonstrates that, in the setting of myeloma, a cancer that can be treated using highly efficacious oral agents in addition to — or instead of — parenteral chemotherapy, patients with outpatient prescription drug coverage are more likely to receive active care and have longer survival than those without prescription drug coverage,” Adam J. Olszewski, MD, assistant professor at Alpert Medical School of Brown University, and colleagues wrote.

The FDA’s 2006 approval of two immunomodulatory drugs — thalidomide and lenalidomide (Revlimid, Celgene) — and the 2003 approval of bortezomib, a parenterally injected proteasome inhibitor, revolutionized the treatment of myeloma.

The drugs, however, are “substantially more expensive than classic therapies,” which the researchers noted creates a financial barrier for Medicare beneficiaries, who make up the majority of patients in the U.S. diagnosed with myeloma.

The researchers used SEER-Medicare data to identify 9,755 patients diagnosed with myeloma between 2006 and 2011 and who were enrolled in a Medicare Part D plan or other creditable prescription drug coverage.

Patients came from 13 geographic areas inhabited by 28% of the U.S. population and had completed Part A/B Medicare claims from 1 year prior to the diagnosis through December 2013.

Olszewski and colleagues classified patients by the prescription drug coverage they had at the time of diagnosis. Researchers examined treatments received — including active myeloma therapy and classic cytotoxic agents or bortezomib as a first-line regimen — and their impact on OS.

Among the 9,755 beneficiaries, 1,460 (15%; median age, 77 years; 50.3% men) had no prescription drug coverage at diagnosis, 3,282 (34%; median age, 77 years; 52.4% men) had Medicare Part D coverage, 3,607 (37%; median age 77 years; 65.3% men) had another creditable prescription drug coverage plan and 1,405 (14%; median age, 76 years; 41.7% men) were Medicaid dual enrollees.

The number of beneficiaries who received active myeloma care increased from 88% in 2006 to 91% in 2011.

After a median follow-up of 4.9 years, 70% of patients died. Median survival was 2.3 years (95% CI, 2.2-2.4) and 43.2% (95% CI, 42.1-44.1) achieved 3-year OS.

Patients with Medicare Part D appeared 6% more likely to receive active myeloma care, 14% less likely to receive parenteral chemotherapy and 38% less likely to receive classic cytotoxic agents than those without coverage. Patients with another creditable prescription drug coverage plan were 3% more likely to receive active myeloma care.

The researchers found some beneficiaries actively changed their prescription coverage status after the myeloma diagnosis, with 41% of patients without coverage obtaining Medicare Part D or other creditable prescription plan.

Researchers conducted 3-year restricted mean survival time (RMST) analyses to evaluate survival outcomes between the groups. They found improved survival among patients with Medicare Part D coverage (adjusted RMST ratio = 1.16; 95% CI, 1.11-1.2) or other creditable prescription coverage (adjusted RMST ratio = 1.16; 95% CI, 1.12-1.21).

“Oncologists should identify resources with which to assist their patients in navigating the complex system of Part D coverage rules and plans, thereby helping to optimize the choice and outcomes of therapy,” Olszewski and colleagues wrote.

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