High-cost cancer drug use in Medicare Advantage and traditional Medicare

High-cost cancer drug use in Medicare Advantage and traditional Medicare
JAMA Health Forum; by Cathy J. Bradley, Rifei Liang, Richard C. Lindrooth, Lindsay M. Sabik, Marcelo C. Perraillon; 1/25
Traditional Medicare’s (TM) fee-for-service reimbursement encourages clinicians to provide higher-cost care, including prescribing expensive drugs when similar less expensive drugs are available. Medicare Advantage (MA) plans, where beneficiaries receive managed care almost exclusively from in-network hospitals and clinicians, were designed to reduce costs by paying a risk-adjusted capitated amount per member. In this cohort study of 4,240 patients with colorectal cancer (CRC) or non–small cell lung cancer (NSCLC), those with local or regional CRC who were insured by MA were less likely to receive a cancer drug, and of those patients, were less likely to receive a high-cost cancer drug than similar patients who were insured by TM. Patients diagnosed with distant NSCLC were less likely to receive a cancer drug if insured by MA compared to TM. MA appears to reduce high-cost drug utilization to treat patients with CRC, but not to treat those with NSCLC, in which few low-cost treatments exist.