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Prescription drug coverage at diagnosis is associated with outcomes among Medicare beneficiaries with myeloma, according to new research.
Patients enrolled in a Medicare Part D plan (PDP) and those with other creditable prescription drug coverage (OCC) at the time of myeloma diagnosis were more likely to receive active care and had better overall survival (OS) than Medicare beneficiaries with no drug coverage.
Adam Olszewski, MD, of Rhode Island Hospital in Providence, and his colleagues reported these findings in the Journal of Clinical Oncology.
The researchers looked at 9755 patients diagnosed with myeloma from 2006 to 2011, assessing the patients’ first-line treatment and OS.
The team classified patients according to the prescription drug coverage they had at myeloma diagnosis. There were 1460 patients with no prescription drug coverage, 3283 with PDP, 3607 with OCC, and 1405 with dual eligibility for Medicare and Medicaid coverage.
Treatment
In a multivariate analysis, PDP beneficiaries were 6% more likely than beneficiaries with no drug coverage to receive active care for myeloma.
However, PDP beneficiaries were 14% less likely to receive parenteral chemotherapy and 38% less likely to receive classic cytotoxic agents. The use of bortezomib-based regimens was similar between PDP patients and those with no drug coverage.
Beneficiaries with OCC were 3% more likely than those with no drug coverage to receive active myeloma care. The use of parenteral chemotherapy, classic cytotoxic agents, and bortezomib-based regimens was similar between the OCC group and the group without drug coverage.
Medicare/Medicaid dual enrollees were about as likely as beneficiaries with no drug coverage to receive active myeloma care. However, the dual enrollees were less likely to receive parenteral chemotherapy, classic cytotoxic agents, and bortezomib-based regimens.
Survival
The median follow-up was 4.9 years. The median survival for all myeloma patients was 2.3 years, and the 3-year OS was 43.1%.
The researchers noted that, among the beneficiaries without drug coverage at diagnosis, 41% had obtained PDP or OCC by the following January. Even so, their OS was significantly worse than beneficiaries who had PDP or OCC at diagnosis.
In a multivariate analysis, OS was 16% longer in both the PDP group and the OCC group than in the group without drug coverage at diagnosis. OS was 8% longer for dual enrollees than for patients without drug coverage.
Dr Olszewski and his colleagues noted that survival differences were largest during the first year and decreased over time as more patients without drug coverage obtained coverage.
The researchers said they couldn’t determine whether the worse OS in the group without drug coverage was the result of not receiving therapy, lack of access to immunomodulatory drugs, or other medical issues.
The team also said their findings should be interpreted with caution because the survival results are “confounded by multiple baseline factors and mediated by the quality of cancer treatment.”
Still, the results “strongly suggest that patients with myeloma without prescription drug coverage may not have received the most effective first-line therapy,” Dr Olszewski and his colleagues wrote.
“Survival for PDP and OCC groups remained identical, which supports the notion that having any prescription drug coverage contributed to optimal treatment and outcomes.”
Prescription drug coverage at diagnosis is associated with outcomes among Medicare beneficiaries with myeloma, according to new research.
Patients enrolled in a Medicare Part D plan (PDP) and those with other creditable prescription drug coverage (OCC) at the time of myeloma diagnosis were more likely to receive active care and had better overall survival (OS) than Medicare beneficiaries with no drug coverage.
Adam Olszewski, MD, of Rhode Island Hospital in Providence, and his colleagues reported these findings in the Journal of Clinical Oncology.
The researchers looked at 9755 patients diagnosed with myeloma from 2006 to 2011, assessing the patients’ first-line treatment and OS.
The team classified patients according to the prescription drug coverage they had at myeloma diagnosis. There were 1460 patients with no prescription drug coverage, 3283 with PDP, 3607 with OCC, and 1405 with dual eligibility for Medicare and Medicaid coverage.
Treatment
In a multivariate analysis, PDP beneficiaries were 6% more likely than beneficiaries with no drug coverage to receive active care for myeloma.
However, PDP beneficiaries were 14% less likely to receive parenteral chemotherapy and 38% less likely to receive classic cytotoxic agents. The use of bortezomib-based regimens was similar between PDP patients and those with no drug coverage.
Beneficiaries with OCC were 3% more likely than those with no drug coverage to receive active myeloma care. The use of parenteral chemotherapy, classic cytotoxic agents, and bortezomib-based regimens was similar between the OCC group and the group without drug coverage.
Medicare/Medicaid dual enrollees were about as likely as beneficiaries with no drug coverage to receive active myeloma care. However, the dual enrollees were less likely to receive parenteral chemotherapy, classic cytotoxic agents, and bortezomib-based regimens.
Survival
The median follow-up was 4.9 years. The median survival for all myeloma patients was 2.3 years, and the 3-year OS was 43.1%.
The researchers noted that, among the beneficiaries without drug coverage at diagnosis, 41% had obtained PDP or OCC by the following January. Even so, their OS was significantly worse than beneficiaries who had PDP or OCC at diagnosis.
In a multivariate analysis, OS was 16% longer in both the PDP group and the OCC group than in the group without drug coverage at diagnosis. OS was 8% longer for dual enrollees than for patients without drug coverage.
Dr Olszewski and his colleagues noted that survival differences were largest during the first year and decreased over time as more patients without drug coverage obtained coverage.
The researchers said they couldn’t determine whether the worse OS in the group without drug coverage was the result of not receiving therapy, lack of access to immunomodulatory drugs, or other medical issues.
The team also said their findings should be interpreted with caution because the survival results are “confounded by multiple baseline factors and mediated by the quality of cancer treatment.”
Still, the results “strongly suggest that patients with myeloma without prescription drug coverage may not have received the most effective first-line therapy,” Dr Olszewski and his colleagues wrote.
“Survival for PDP and OCC groups remained identical, which supports the notion that having any prescription drug coverage contributed to optimal treatment and outcomes.”
Prescription drug coverage at diagnosis is associated with outcomes among Medicare beneficiaries with myeloma, according to new research.
Patients enrolled in a Medicare Part D plan (PDP) and those with other creditable prescription drug coverage (OCC) at the time of myeloma diagnosis were more likely to receive active care and had better overall survival (OS) than Medicare beneficiaries with no drug coverage.
Adam Olszewski, MD, of Rhode Island Hospital in Providence, and his colleagues reported these findings in the Journal of Clinical Oncology.
The researchers looked at 9755 patients diagnosed with myeloma from 2006 to 2011, assessing the patients’ first-line treatment and OS.
The team classified patients according to the prescription drug coverage they had at myeloma diagnosis. There were 1460 patients with no prescription drug coverage, 3283 with PDP, 3607 with OCC, and 1405 with dual eligibility for Medicare and Medicaid coverage.
Treatment
In a multivariate analysis, PDP beneficiaries were 6% more likely than beneficiaries with no drug coverage to receive active care for myeloma.
However, PDP beneficiaries were 14% less likely to receive parenteral chemotherapy and 38% less likely to receive classic cytotoxic agents. The use of bortezomib-based regimens was similar between PDP patients and those with no drug coverage.
Beneficiaries with OCC were 3% more likely than those with no drug coverage to receive active myeloma care. The use of parenteral chemotherapy, classic cytotoxic agents, and bortezomib-based regimens was similar between the OCC group and the group without drug coverage.
Medicare/Medicaid dual enrollees were about as likely as beneficiaries with no drug coverage to receive active myeloma care. However, the dual enrollees were less likely to receive parenteral chemotherapy, classic cytotoxic agents, and bortezomib-based regimens.
Survival
The median follow-up was 4.9 years. The median survival for all myeloma patients was 2.3 years, and the 3-year OS was 43.1%.
The researchers noted that, among the beneficiaries without drug coverage at diagnosis, 41% had obtained PDP or OCC by the following January. Even so, their OS was significantly worse than beneficiaries who had PDP or OCC at diagnosis.
In a multivariate analysis, OS was 16% longer in both the PDP group and the OCC group than in the group without drug coverage at diagnosis. OS was 8% longer for dual enrollees than for patients without drug coverage.
Dr Olszewski and his colleagues noted that survival differences were largest during the first year and decreased over time as more patients without drug coverage obtained coverage.
The researchers said they couldn’t determine whether the worse OS in the group without drug coverage was the result of not receiving therapy, lack of access to immunomodulatory drugs, or other medical issues.
The team also said their findings should be interpreted with caution because the survival results are “confounded by multiple baseline factors and mediated by the quality of cancer treatment.”
Still, the results “strongly suggest that patients with myeloma without prescription drug coverage may not have received the most effective first-line therapy,” Dr Olszewski and his colleagues wrote.
“Survival for PDP and OCC groups remained identical, which supports the notion that having any prescription drug coverage contributed to optimal treatment and outcomes.”