Did changes in drug reimbursement after the medicare modernization act affect chemotherapy prescribing?

Abstract

Purpose: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) decreased fee-for-service (FFS) payments for outpatient chemotherapy. We assessed how this policy affected chemotherapy in FFS settings versus in integrated health networks (IHNs).

Patients and methods: We examined 5,831 chemotherapy regimens for 3,613 patients from 2003 to 2006 with colorectal cancer (CRC) or lung cancers in the Cancer Care Outcomes Research Surveillance Consortium. Patients were from four geographically defined regions, seven large health maintenance organizations, and 15 Veterans Affairs Medical Centers. The outcome of interest was receipt of chemotherapy that included at least one drug for which reimbursement declined after the MMA.

Results: The odds of receiving an MMA-affected drug were lower in the post-MMA era: the odds ratio (OR) was 0.73 (95% CI, 0.59 to 0.89). Important differences across cancers were detected: for CRC, the OR was 0.65 (95% CI, 0.46 to 0.92); for non-small-cell lung cancer (NSCLC), the OR was 1.60 (95% CI, 1.09 to 2.35); and for small-cell lung cancer, the OR was 0.63 (95% CI, 0.34 to 1.16). After the MMA, FFS patients were less likely to receive MMA-affected drugs: OR, 0.73 (95% CI, 0.59 to 0.89). No pre- versus post-MMA difference in the use of MMA-affected drugs was detected among IHN patients: OR, 1.01 (95% CI, 0.66 to 1.56). Patients with CRC were less likely to receive an MMA-affected drug in both FFS and IHN settings in the post- versus pre-MMA era, whereas patients with NSCLC were the opposite: OR, 1.60 (95% CI, 1.09 to 2.35) for FFS and 6.33 (95% CI, 2.09 to 19.11) for IHNs post- versus pre-MMA.

Conclusion: Changes in reimbursement after the passage of MMA appear to have had less of an impact on prescribing patterns in FFS settings than the introduction of new drugs and clinical evidence as well as other factors driving adoption of new practice patterns.

Fig 1.

Decomposition of cancer drug regimens over time for Cancer Care Outcomes Research and Surveillance participants: proportions of regimens including drugs affected by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) versus regimens with only unaffected drugs overall. Q, quarter.

Fig 2.

Decomposition of cancer drug regimens over time for Cancer Care Outcomes Research and Surveillance participants: proportions of regimens including drugs affected by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) versus regimens with only unaffected drugs by type of health system. FFS, fee-for-service; IHN, integrated health network; Q, quarter.

Fig A1.

Log odds of receipt of regimen containing drugs affected by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (unstratified). Q, quarter.

Fig A2.

Log odds of receipt of regimen containing drugs affected by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (stratified by health plan). FFS, fee-for-service; IHN, integrated health network; Q, quarter.