Abstract C107: Trends in utilization and cost of lung cancer targeted therapies by rural-urban status, 2013–2023

Abstract Background: Lung cancer is the leading cause of cancer death in the United States. Targeted therapies offer a personalized approach to treating lung cancer by targeting specific genetic mutations in tumors. These therapies are generally costlier than traditional systemic therapies, which may pose a barrier to access. We examined changes in the number of prescriptions and average cost per claim for lung cancer targeted therapies in the past decade using data from Medicare Part D, covering outpatient drug costs for over 50 million adults aged ≥65 years and individuals with disabilities. Methods: This study analyzed Medicare Part D prescriber data from 2013 to 2023 using the publicly available “by provider” and “by provider and drug” files released by the Centers for Medicare & Medicaid Services (CMS). A total of 39,168 prescription records for lung cancer targeted therapies were identified from 8,879 distinct providers, based on generic names compiled from National Institutes of Health sources. Providers’ addresses were geocoded using the U.S. Census Geocoder and ArcGIS Pro to derive county and Health Service Area (HSA) identifiers, while Rural-Urban Commuting Area (RUCA) codes were obtained from CMS data and categorized as metropolitan, micropolitan, small town, and rural areas. We examined the (1) number of HSAs with prescribing providers, (2) number and average cost per claim, and (3) cost per claim across RUCA categories in 2013-2015 and 2021-2023, with differences tested using Welch’s ANOVA. Results: The number of prescription records increased from 8,267 in 2013-2015 to 14,600 in 2021-2023. Metropolitan providers accounted for 94.0% of prescription records (7,771 out of 8,267) and 96.0% of total claims (169,529 out of 176,126) in 2013-2015, and 95.2% of prescription records (13,894 out of 14,600) and 96.0% of total claims (288,505 out of 300,465) in 2021-2023. However, the number of HSAs with prescribing providers remained relatively stable, 531 in 2013-2015 and 522 in 2021-2023. From 2013-2015 to 2021-2023, the average cost per claim more than doubled ($6,239 to $14,429), with the largest increase in rural areas ($5,781 to $14,586). In 2013-2015, an ANOVA test showed a significant difference in average cost per claim across RUCA categories (p<0.01): metropolitan ($6,251), micropolitan ($6,065), small town ($5,737), and rural ($5,781). In 2021-2023, the ANOVA test showed no significant difference (p=0.26): metropolitan ($14,470), micropolitan ($13,494), and small town ($12,711), and rural areas ($14,586). Conclusion: From 2013-2015 to 2021-2023, lung cancer targeted therapies under Medicare Part D showed a significant growth in the number of prescriptions, reflecting increased adoption of these therapies. During the same period, however, cost per claim substantially increased. The average cost per claim in 2013-2015 showed differed across RUCA codes, with a higher cost in metropolitan areas. In 2021-2023, however, the average cost was similar across RUCA categories. Citation Format: Dongjun Lee, Daniel Wiese, Ahmedin Jemal, Farhad Islami. Trends in utilization and cost of lung cancer targeted therapies by rural-urban status, 2013–2023 [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C107.