Upfront Out-of-Pocket Costs for Expensive TKIs Could Cause Medicare Beneficiaries With Chronic Myeloid Leukemia to Delay Treatment

A study published in the Journal of Clinical Oncology found that Medicare beneficiaries with chronic myeloid leukemia (CML) who incurred significant upfront out-of-pocket costs prior to benefit activation were more likely to delay treatment.

Aaron N. Winn, of the University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, and authors observed 393 older patients (≥66 years old) who were diagnosed with CML between 2007 and 2011 (using SEER-Medicare data) and found that just 68 percent of patients started treatment with a tyrosine kinase inhibitor within six months after diagnosis. However, patients who had access to subsidies (those with an annual income <$17,820 and <$13,640 in assets) to help cover the cost of those drugs started treatment 50 days earlier than those who did not (median to treatment initiation = 58 days vs. 108 days, respectively). Overall, patients with subsidies were 35 percent more likely to start the drugs faster.

Eventually, treatment initiation and adherence evened out between the groups. At 90 days, 48 percent of Medicare recipients without subsidies had started treatment, compared with 63 percent of those with subsidies; at six months, 64 percent and 65 percent, respectively, had started treatment.

“Delayed initiation among individuals without cost-sharing subsidies suggests that out-of-pocket costs may be a barrier to timely initiation of therapy among individuals diagnosed with CML,” the authors concluded.

Source: Winn AN, Keating NL, Dusetzina SB. Factors associated with tyrosine kinase inhibitor initiation and adherence among Medicare beneficiaries with chronic myeloid leukemia. J Clin Oncol. 2016 October 3. [Epub ahead of print]