Prescription Drug Coverage Key in Multiple Myeloma Therapy

Multiple myeloma patients who had prescription drug coverage were more likely to receive active myeloma care and less likely to use parenteral treatments or other classic cytotoxic agents to treat their disease, according to the results of a study published in The Journal of Clinical Oncology.

“As most patients with myeloma in the United States are covered by Medicare, our results have important implications both for the clinicians who care for these patients and for healthcare policy that tackles coverage or oral and parenteral anticancer therapy,” wrote Adam J. Olszewski, MD, of the Warren Alpert Medical School of Brown University, Richmond, Rhode Island, and colleagues.

“In the setting of myeloma, a cancer that can be treated using highly efficacious oral agents in addition to-or instead of-parenteral chemotherapy, patients with outpatient prescription drug coverage are more likely to receive active care and have longer survival than those without prescription drug coverage,” the researchers wrote. “Providing more equitable access to oral and parenteral chemotherapy options may thus enhance outcomes in myeloma and, hypothetically, other cancers that are treatable with oral targeted agents.”

According to the study, standard Medicare benefits only cover parenteral drugs for the treatment of myeloma. Using SEER-Medicare data, Olsewski and colleagues looked at possible associations between prescription drug coverage, receipt of therapy, and survival among beneficiaries.

The study included 9,755 beneficiaries with Medicare Part D plan or other creditable prescription drug coverage. All patients were diagnosed from 2006–2011. The researchers used beneficiaries with diffuse large B-cell lymphoma (DLBCL), a cancer treated with parenteral chemotherapy, as a comparison cohort.

Of the included participants, 15% had no prescription drug coverage at diagnosis, 34% had Medicare Part D, 37% had other coverage, and 14% were Medicaid dual enrollees.

Treatment differed significantly based on the type of prescription drug coverage. Adjusting for baseline characteristics, the study showed that compared to those with no coverage, Medicare Part D enrollees were 6% more likely to receive active care and 14% less likely to receive parenteral care. PDP enrollees were also 38% less likely to receive classic cytotoxic agents. Similarly, participants with other coverage were 3% more likely to receive active myeloma care. However, these patients received similar rates of parenteral regimens as those without prescription coverage.

Four in 10 enrollees who did not have prescription coverage at diagnosis enrolled after the myeloma diagnosis.

Participants with Medicare Part D or other coverage had a 16% longer survival compared with those with no prescription coverage. There was no difference in survival based on prescription drug coverage for patients with DLBCL.

“The primary limitation of this analysis is that unobserved clinical differences between beneficiaries with and without prescription drug coverage could have accounted for the differences in mortality; however, we observed lower prevalence of anemia, kidney disease, and other comorbidities among beneficiaries without coverage compared with the Medicare Part D group,” the researchers wrote. “Furthermore, use of the negative control DLBCL cohort, which demonstrated no survival differences, supports our findings.”

Commenting on the results of the study, Vincent Rajkumar, MD, of Mayo Clinic, Rochester, Minnesota, said the primary conclusion was that when patients had access to oral drugs through prescription drug coverage their survival was significantly better.

"This is very important, particularly for a disease like multiple myeloma where there is a lot of racial disparities and outcome is affected by access," Rajkumar said. "A lot of the drugs used for myeloma are oral drugs and without good prescription drug access, patients won't have access to these important treatments."