Since 2006, Medicare Part D has helped millions of American seniors gain access to their prescribed medications. In particular, the federal prescription medication coverage program has been remarkably effective for helping individuals with the blood cancer multiple myeloma in accessing their medicines. According to a new study published in the Journal of Clinical Oncology, not only has the program increased the use of newer or oral anticancer therapies among people with multiple myeloma, but may also be associated with helping those patients live longer.
For this year’s Multiple Myeloma Action Month, study author and Yale University professor Amy J. Davidoff, Ph.D., explains how Medicare Part D may have an impact on patient outcomes and what this means for the future of access to oral therapies for cancer.
How does Part D impact what treatment a patient receives for multiple myeloma?
“It’s a complicated situation because there are the oral and IV (intravenous) options for multiple myeloma treatment. The out-of-pocket costs depend not only on the medication’s method of delivery but also on whether a patient has supplemental medical coverage (e.g. Medigap), prescription medication coverage or both.
These supplemental coverage programs are vital to protecting patients from large out-of-pocket burdens. In some cases, the types of coverage they have may lead them to choose one therapy over another or enable them to afford a combination of medications, which is common for multiple myeloma.”
Does Part D and other insurance plans impact survival for multiple myeloma?
“Our study revealed that multiple myeloma patients were more likely to receive any myeloma therapy, but less likely to received older IV therapies if they had prescription medication coverage compared to those without such coverage. We could not directly observe, but presume that they were receiving oral therapy. Patients covered by Part D or other creditable prescription medication coverage programs had median overall survivals that were 16 percent higher than the non-covered group.
Prescription drug coverage becomes an important part of the equation when patients have the option to take oral therapies, which is the case with multiple myeloma.
Why is prescription medication coverage particularly important in multiple myeloma?
“Prescription drug coverage becomes an important part of the equation when patients have the option to take oral therapies, which is the case with multiple myeloma. Patients with other cancers, such as diffuse large B cell lymphoma, are most often prescribed IV chemotherapy, which is administered in an outpatient setting and is covered under a patient’s medical benefits. As a result, our study found Medicare beneficiaries with this lymphoma saw no significant difference in survival with Part D coverage.
Oral therapies for multiple myeloma, however, were introduced in 2006, so our study was able to cover an adequate period of their use, from 2006 to 2013. During the last decade, oral therapies have been developed for other malignancies such as breast cancer and melanoma. As time progresses, we could see similar research on prescription coverage and patients with various cancers.”
Why don’t more seniors opt for prescription medication coverage?
“The few seniors who decline Part D coverage may perceive themselves as relatively healthy. They may assess the cost of Medicare Part D coverage compared to the cost of their current medications and decide that they don’t need to enroll. Health care professionals understand that your health status today does not necessarily determine your status tomorrow, but not all people understand the risk of future health problems and may not understand the potential risks of not enrolling.
Many of those seniors regret this decision later on. For example, 41 percent of non-covered patients enrolled in a prescription plan the year after being diagnosed with multiple myeloma. There is definitely an ongoing need to better inform the Medicare population of their coverage options during open enrollment.”
What are your thoughts on the implementation of Part D and its future?
“We need to change the way seniors enroll in Medicare programs. The process as it is now is confusing and far from ideal. There are a lot of opportunities to improve the enrollment site and provide beneficiaries with better information.
In addition, there’s a need to establish better caps on out-of-pocket costs. This would be very useful. The goal is to make prescription medication coverage as affordable as possible for Medicare beneficiaries.”
To learn why policymakers must act to protect prescription coverage for America’s seniors, read “Medicare Part D: Challenges Loom Ahead.”