Patient cost sharing and receipt of erythropoiesis-stimulating agents through medicare part D

Amy J. Davidoff, Franklin B. Hendrick, Amer M. Zeidan, Maria R. Baer, Bruce C. Stuart, Rahul A. Shenolikar, Steven D. Gore

Research output: Contribution to journalArticle

Abstract

Purpose: Medicare Part D prescription benefits cover injected medications, normally covered under Part B, when administered outside of physician offices. Erythropoiesis-stimulating agents (ESAs) used for chronic anemia management in patients with myelodysplastic syndromes (MDS) are commonly injected in a physician office but can be administered safely at home. In this study, we explored out-of-pocket (OOP) costs and receipt of Part D-covered ESAs in Medicare beneficiaries with MDS. Materials and Methods: Patients with MDS enrolled in Medicare Parts A, B, and D were identified using diagnosis codes from 100% claims from 2006 to 2008. OOP costs for the mean erythropoietin alfa claim were compared for Parts B and D. Multivariable models examined the effect of low-income subsidy (LIS) and other Part D cost sharing on receipt of any ESA and any Part D-covered ESA. Results: A total of 13,117 (62.9%) of 20,848 patients received ESAs, but only 1,436 (6.9%) had any Part D claim. OOP payment was $348 under Part D versus $161 under Part B. Among patients with ESA use, those with LIS were 4x more likely to receive Part D ESAs (P <.01). Conclusion: Few patients with MDS received ESAs through Part D. OOP payments required under Part D were substantially higher than under Part B. Cost sharing, as reflected by LIS receipt, likely affected decisions to prescribe ESAs outside of the physician office. Improved coordination between Part B and D benefits regarding issues of home injection of medications may create incentives that improve patient access and convenience and reduce costs associated with administration.

Original languageEnglish (US)
Pages (from-to)e190-e198
JournalJournal of Oncology Practice
Volume11
Issue number2
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Medicare Part D
Cost Sharing
Hematinics
Myelodysplastic Syndromes
Health Expenditures
Physicians' Offices
Medicare Part A
Medicare Part B
Erythropoietin
Medicare
Prescriptions
Motivation
Anemia

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Davidoff, A. J., Hendrick, F. B., Zeidan, A. M., Baer, M. R., Stuart, B. C., Shenolikar, R. A., & Gore, S. D. (2015). Patient cost sharing and receipt of erythropoiesis-stimulating agents through medicare part D. Journal of Oncology Practice, 11(2), e190-e198. https://doi.org/10.1200/JOP.2014.001527

Patient cost sharing and receipt of erythropoiesis-stimulating agents through medicare part D. / Davidoff, Amy J.; Hendrick, Franklin B.; Zeidan, Amer M.; Baer, Maria R.; Stuart, Bruce C.; Shenolikar, Rahul A.; Gore, Steven D.

In: Journal of Oncology Practice, Vol. 11, No. 2, 01.03.2015, p. e190-e198.

Research output: Contribution to journalArticle

Davidoff, AJ, Hendrick, FB, Zeidan, AM, Baer, MR, Stuart, BC, Shenolikar, RA & Gore, SD 2015, 'Patient cost sharing and receipt of erythropoiesis-stimulating agents through medicare part D', Journal of Oncology Practice, vol. 11, no. 2, pp. e190-e198. https://doi.org/10.1200/JOP.2014.001527
Davidoff AJ, Hendrick FB, Zeidan AM, Baer MR, Stuart BC, Shenolikar RA et al. Patient cost sharing and receipt of erythropoiesis-stimulating agents through medicare part D. Journal of Oncology Practice. 2015 Mar 1;11(2):e190-e198. https://doi.org/10.1200/JOP.2014.001527
Davidoff, Amy J. ; Hendrick, Franklin B. ; Zeidan, Amer M. ; Baer, Maria R. ; Stuart, Bruce C. ; Shenolikar, Rahul A. ; Gore, Steven D. / Patient cost sharing and receipt of erythropoiesis-stimulating agents through medicare part D. In: Journal of Oncology Practice. 2015 ; Vol. 11, No. 2. pp. e190-e198.
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abstract = "Purpose: Medicare Part D prescription benefits cover injected medications, normally covered under Part B, when administered outside of physician offices. Erythropoiesis-stimulating agents (ESAs) used for chronic anemia management in patients with myelodysplastic syndromes (MDS) are commonly injected in a physician office but can be administered safely at home. In this study, we explored out-of-pocket (OOP) costs and receipt of Part D-covered ESAs in Medicare beneficiaries with MDS. Materials and Methods: Patients with MDS enrolled in Medicare Parts A, B, and D were identified using diagnosis codes from 100{\%} claims from 2006 to 2008. OOP costs for the mean erythropoietin alfa claim were compared for Parts B and D. Multivariable models examined the effect of low-income subsidy (LIS) and other Part D cost sharing on receipt of any ESA and any Part D-covered ESA. Results: A total of 13,117 (62.9{\%}) of 20,848 patients received ESAs, but only 1,436 (6.9{\%}) had any Part D claim. OOP payment was $348 under Part D versus $161 under Part B. Among patients with ESA use, those with LIS were 4x more likely to receive Part D ESAs (P <.01). Conclusion: Few patients with MDS received ESAs through Part D. OOP payments required under Part D were substantially higher than under Part B. Cost sharing, as reflected by LIS receipt, likely affected decisions to prescribe ESAs outside of the physician office. Improved coordination between Part B and D benefits regarding issues of home injection of medications may create incentives that improve patient access and convenience and reduce costs associated with administration.",
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AU - Stuart, Bruce C.

AU - Shenolikar, Rahul A.

AU - Gore, Steven D.

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N2 - Purpose: Medicare Part D prescription benefits cover injected medications, normally covered under Part B, when administered outside of physician offices. Erythropoiesis-stimulating agents (ESAs) used for chronic anemia management in patients with myelodysplastic syndromes (MDS) are commonly injected in a physician office but can be administered safely at home. In this study, we explored out-of-pocket (OOP) costs and receipt of Part D-covered ESAs in Medicare beneficiaries with MDS. Materials and Methods: Patients with MDS enrolled in Medicare Parts A, B, and D were identified using diagnosis codes from 100% claims from 2006 to 2008. OOP costs for the mean erythropoietin alfa claim were compared for Parts B and D. Multivariable models examined the effect of low-income subsidy (LIS) and other Part D cost sharing on receipt of any ESA and any Part D-covered ESA. Results: A total of 13,117 (62.9%) of 20,848 patients received ESAs, but only 1,436 (6.9%) had any Part D claim. OOP payment was $348 under Part D versus $161 under Part B. Among patients with ESA use, those with LIS were 4x more likely to receive Part D ESAs (P <.01). Conclusion: Few patients with MDS received ESAs through Part D. OOP payments required under Part D were substantially higher than under Part B. Cost sharing, as reflected by LIS receipt, likely affected decisions to prescribe ESAs outside of the physician office. Improved coordination between Part B and D benefits regarding issues of home injection of medications may create incentives that improve patient access and convenience and reduce costs associated with administration.

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