Mean spending per beneficiary is calculated for each drug, dividing the total spending for that drug by total number of unique beneficiaries using that drug.
eMethods 1. CMS Medicare Drug Spending Public Use Files (PUF) Variables
eMethods 2. Adjusting for Medicare Advantage Enrollment
eTable 1. Medicare Advantage Share of Total Medicare Program Enrollment
eMethods 3. Count of Oncology Drugs and Mutually Exclusive Assignment to Parts B and D
eTable 2. Primary Program Assignment for Overlapping Drugs
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Kyle MA, Dusetzina SB, Keating NL. Evaluation of Trends in Oncology Drug Spending in Medicare, 2016 to 2020. JAMA Netw Open. 2022;5(7):e2221468. doi:10.1001/jamanetworkopen.2022.21468
Oncology prescription drug spending concerns policy makers, physicians, and patients. Historically, anticancer medications were delivered via infusion and were covered under a patient’s medical benefit (Medicare Part B). Recent decades have seen the rise of highly effective, orally administered anticancer drugs for certain cancer types covered under outpatient prescription drug benefits (Medicare Part D), for which very high out-of-pocket costs may contribute to financial toxicity.1,2 We examined drug spending in Medicare Parts B and D to document trends in oncology drug entrants, use, and spending over time and described the share of total use and spending attributed to oncology drugs within each program.
This cross-sectional study incorporated data from the 2016-2020 Medicare Parts B and D Drug Spending Dashboard Public Use Files (eMethods 1 in the Supplement). We used the Oncology Care Model drug lists,3 current through 2021, to identify oncology drugs. Because the study did not involve human participants, approval was waived by the Harvard Medical School Institutional Review Board. This study followed the STROBE reporting guideline.
For each program and year, we calculated the following measures overall and for all drugs, oncology drugs, and nononcology drugs: number of drugs, total spending, total claims, total unique beneficiaries using each drug (the metric reported in the dashboards), and mean and median spending per claim and beneficiary-drug combination. We adjusted Part B data using Medicare enrollment percentages to account for missing Medicare Advantage beneficiaries, whose utilization patterns and cancer prevalence are consistent with those of traditional Medicare beneficiaries (eMethods 2 and eTable 1 in the Supplement).4,5 Using the total number of oncology drugs in Parts B and D as the denominator, we calculated the share of drugs, claims, and spending across each program (eMethods 3 and eTable 2 in the Supplement).
Between January 1, 2016, and December 31, 2020, the share of all Part B drugs used for oncology indications increased slightly from 97 of 484 (20.0%) to 136 of 603 (22.5%) (Table). Among beneficiaries receiving Part B drugs, the proportion receiving oncology drugs was unchanged (from 3.0% to 3.2%). During the same period, the oncology proportion of Part B drug spending increased from 33.7% to 43.1%.
The share of all Part D drugs used for oncology indications increased slightly from 84 of 2721 (3.1%) to 141 of 3576 (3.9%) from 2016 to 2020 (Table). Although the proportion of Part D beneficiaries receiving oncology drugs remained consistent at 0.6%, the proportion of Part D drug spending on oncology drugs increased from 9.1% to 13.2% from 2016 to 2020.
At the beneficiary-drug level, Part B spending increased modestly overall and for nononcology drugs, but median annual oncology drug spending per beneficiary increased from $9325 (IQR, $750-$29 256) to $18 761 (IQR, $1197-$39 335) from 2016 to 2020 (Figure). Part D median per beneficiary oncology drug spending accelerated similarly from $27 761 (IQR, $2088-$53 834) to $52 016 (IQR, $6472-76,894) from 2016 to 2020.
The proportion of oncology drugs covered by Parts D vs B increased slightly over time. Of 181 oncology drugs in 2016, 84 (46.4%) were Part D. Of 277 drugs in 2020, 141 (50.9%) were Part D (Table).
Within Medicare Parts B and D, the oncology percentage of total drugs and percentage of beneficiaries using oncology drugs were relatively stable, but oncology drug spending increased markedly between 2016 and 2020, both overall and per beneficiary. Study limitations include an inability to disaggregate off-label or nononcology uses of drugs. Nevertheless, these findings underscore the need for attention to the accelerating costs of oncology drugs—particularly oral drugs—and diminishing affordability for patients and the Medicare program.
For Medicare beneficiaries with cancer, Part D accounts for an increasing share of new drugs whose high and rising out-of-pocket costs may contribute to financial toxicity and noninitiation of or nonadherence to oral therapies.6 This has consequential policy implications: efforts to cap patient out-of-pocket spending in Part D may disproportionately benefit people with cancer, given these coverage dynamics.
Accepted for Publication: May 25, 2022.
Published: July 13, 2022. doi:10.1001/jamanetworkopen.2022.21468
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Kyle MA et al. JAMA Network Open.
Corresponding Author: Michael Anne Kyle, PhD, RN, Department of Health Care Policy, Harvard Medical School, 180A Longwood Ave, Boston, MA 02115 (email@example.com).
Author Contributions: Dr Kyle had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Kyle, Keating.
Drafting of the manuscript: Kyle.
Critical revision of the manuscript for important intellectual content: Dusetzina, Keating.
Statistical analysis: Kyle.
Conflict of Interest Disclosures: Dr Kyle reported receiving grants from the National Cancer Institute (NCI) during the conduct of the study. Dr Dusetzina reported receiving grants from Arnold Ventures LLC, Commonwealth Fund, and the NCI during the conduct of the study; receiving grants from the Robert Wood Johnson Foundation and Leukemia & Lymphoma Society and personal fees from the Institute for Clinical and Economic Review, West Health, and National Academy for State Health Policy outside the submitted work; and serving on the Medicare Payment Advisory Commission. Dr Keating reported receiving grants from the NCI, Centers for Medicare & Medicaid Services, Arnold Ventures LLC, and the Commonwealth Fund during the conduct of the study. No other disclosures were reported.
Funding/Support: This study was supported by training grant 5T32CA092203 from the NCI (Dr Kyle) and grants from Arnold Ventures LLC (Dr Dusetzina) and the Commonwealth Fund (Dr Dusetzina).
Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The views presented are those of the authors and do not reflect those of the Medicare Payment Advisory Commission.