Patients with multiple myeloma (MM) who are enrolled in a Medicare Part D plan or other creditable prescription drug coverage have better survival than patients without prescription drug coverage. According to a study in Journal of Clinical Oncology, this improved survival seemed to be a result of patients having access to all treatment options.
Patients with multiple myeloma (MM) who are enrolled in a Medicare Part D plan (PDP) or other creditable prescription drug coverage (OCC) have better survival than patients without prescription drug coverage. According to a study in Journal of Clinical Oncology, this improved survival seemed to be a result of patients having access to all treatment options.
Before the approval of bortezomib, a parenterally injected proteasome inhibitor, in 2003, and the immunomodulatory drugs (IMiDs) thalidomide and lenalidomide, both of which are orally administered, in 2006, most older patients with MM were treated with corticosteroids, alkylating agents, or parenteral cytotoxic chemotherapy. While the older drugs were less expensive, the median overall survival (OS) on those treatments was only 3 years. In comparison, bortezomib and the IMiDs improved median survival to 4 to 5 years.
“Both agents are substantially more expensive than classic therapies, which creates a financial barrier for Medicare beneficiaries, who constitute a majority of patients with myeloma in the United States,” the authors explained. “Whereas the traditional Medicare Part B covers most parenteral chemotherapy costs, including bortezomib, it does not pay for most prescription drugs, including IMiDs.”
To examine the association between prescription drug coverage, care received, and subsequent survival, the researchers used SEER-Medicare data to identify enrollment in a Medicare PDP or OCC among 9755 Medicare beneficiaries with MM. Of the 9755 beneficiaries, 15% had no prescription drug coverage, 34% had a PDP, 37% had OCC, and 14% were Medicaid dual enrollees.
The authors found that treatment differed significantly depending on the type of prescription drug coverage. PDP enrollees 6% were more likely to receive active care, 14% less likely to receive parenteral chemotherapy, and 38% less likely to receive classic cytotoxic agents. While OCC enrollees were 3% more likely to receive active care, they were as likely as beneficiaries without coverage to receive parental chemotherapy.
Patients with PDP or OCC had OS that was 10% higher at 1 year and 6% higher at 3 years compared with patients without coverage.
The authors concluded that the study results showed that in a cancer that can be treated with effective oral agents, patients with prescription drug coverage are more likely to receive active care and have longer survival compared with patients who have no drug coverage.
“Providing more equitable access to oral and parenteral chemotherapy options may thus enhance outcomes in myeloma and, hypothetically, other cancers that are treatable with oral targeted agents,” the authors concluded.
Olzsewski AJ, Dusetzina SB, Trivedi AN, Davidoff AJ. Prescription drug coverage and outcomes of myeloma therapy among Medicare beneficiaries. [published online August 16, 2018]. J Clin Oncol. doi: 10.1200/JCO.2018.77.8894.