HSRProj will be retired on September 14, 2021, no updates will be made to HSRProj after this date.
Detailed information about this transition can be found on the
June 3, 2021 Technical Bulletin post.
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Information about ongoing health services research and public health projects
| Effects of commercial insurer payment policy on chemotherapy use and costs | |
|---|---|
| Investigator (PI): | Bekelman, Justin |
| Performing Organization (PO): |
(Current): University of Pennsylvania, Perelman School of Medicine, Department of Radiation Oncology / (800) 789-7366 |
| Supporting Agency (SA): | American Cancer Society |
| Initial Year: | 2015 |
| Final Year: | 2016 |
| Record Source/Award ID: | ACS/RSGI-14-164-01 |
| Funding: | Total Award Amount: $544,000 |
| Award Type: | Grant |
| Abstract: | Cancer accounted for over 500,000 deaths and nearly $125 billion in medical spending in 2010, second only to heart disease. The most costly components of cancer care are chemotherapy drugs, which comprise over three-quarters of oncology practice costs. The costs of cancer care, and particularly chemotherapy drugs, have risen faster than spending in others parts of health care. This trend is largely attributable to a combination of rising chemotherapy prices and increased use. Patient out-of-pocket expenses have grown similarly; these costs are a hidden but burdensome component of cancer care spending today. In 2005, the Medicare Prescription Drug, Improvement and Modernization Act (MMA) substantially reduced reimbursement for chemotherapies. These reductions were associated with an increase in the number of newly diagnosed patients receiving chemotherapy as well as a switch from drugs with the largest profit margin reductions toward high-cost branded drugs that retained high profit margins under the MMA fee schedule. As the effects of the MMA became apparent, UnitedHealthcare (UHC), the largest commercial health insurer in the United States, sought to encourage use of therapeutically equivalent low-cost generic chemotherapies by increasing their reimbursement, thereby creating high-margin generic alternatives to branded drugs. However, the impact of commercial payer reimbursement reforms on practice patterns, in coordination with or in response to the MMA, has received little attention. This limitation has become a pressing knowledge gap in the context of reimbursement reforms directed at all payers in the Affordable Care Act. We seek to answer two central questions: (1) Did UHC reimbursement reforms increase medical oncologists' use of generics for UHC enrollees? and (2) Did changes in medical oncologists' practice patterns that resulted from UHC reimbursement reforms "spillover" to Medicare beneficiaries? The overriding hypothesis is that UHC reimbursement reforms increased use of generic chemotherapies, reducing total and out-of-pocket health care expenditures for UHC enrollees; however, these effects did not spill over to Medicare beneficiaries. We also explore care quality by assessing guideline adherence for UHC enrollees. Our analysis centers on an important clinical setting: chemotherapy use for patients with lung cancer, the nation's leading cause of death from cancer. Our findings will apply to physicians and practices that care for UHC enrollees and Medicare beneficiaries throughout the United States, will inform our understanding of how physicians respond to reimbursement changes, and will enhance our understanding of the effects of reimbursement changes on both overall and patient out-of-pocket spending. |
| MeSH Terms: |
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| Country: | United States |
| State: | Pennsylvania |
| Zip Code: | 19104 |
| UI: | 20163008 |
| Project Status: | Completed |