IMPACT OF HIGH COSTS FOR ORAL ANTICANCER DRUGS: ACCESS, DEATH, AND NET WORTH

Oral anticancer drugs have increased in prevalence and may provide valuable benefit for patients who need them. However, significant out-of-pocket costs contribute to suboptimal oral anticancer drug use in addition to poor health and financial outcomes. Moreover, significant OOP costs may exacerbate racial inequities in such outcomes. The low-income subsidy (LIS) program is designed to alleviate most of the OOP costs for Medicare Part D beneficiaries with low incomes. The study objectives were to examine the association of LIS participation on improvements in access to high-cost oral anticancer drugs, to assess the association of LIS participation with cancer health outcomes, and to assess the association of LIS eligibility with changes in household net worth following a cancer diagnosis. Moreover, this study also sought to examine whether LIS participation or eligibility narrowed racial inequities in each of these outcomes. We used 2006-2018 Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data and the Health and Retirement Study survey to carry out this study. For Aim 1, we used Cox proportional hazards models to assess the relationship between LIS participation (full subsidy vs. partial subsidy vs. no subsidy) and (1) initiation of high-cost oral anticancer drugs; and (2) racial inequities in initiation of high-cost oral anticancer drugs. For Aim 2, we used Cox proportional hazards models and accelerated time failure models to examine the association between LIS participation and (1) overall and cancer-specific mortality; (2) racial inequities in overall and cancer-specific mortality. Finally, in Aim 3, we used generalized linear models with gamma distributions and identity links to examine the association between LIS eligibility and (1) changes in household net worth and (2) racial inequities in changes in household net worth. Although beneficiaries with a full LIS had an increased likelihood of oral anticancer drug initiation, accounting for LIS participation alone did not mitigate observed racial inequities. In terms of overall and cancer-specific mortality, full LIS participation was associated with an increased risk of dying from any cause but showed some potential to mitigate some racial inequities. Eligibility for any LIS (i.e., partial or full) was not protective from reductions in household net worth following a cancer diagnosis. In the context of recent prescription drug reform, including Medicare Part D redesign, understanding the extent to which OOP costs present barriers to accessing treatment or impacting longer term outcomes is warranted.