ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2016
Mind the Gap: Why Closing the Doughnut Hole Is Insufficient for Increasing Medicare Beneficiary Access to Oral Chemotherapy.
Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review.Current oncology (Toronto, Ont.) · 2021Pooled it
- The impact of vertical integration on health care delivery and costs: Evidence from physician-pharmacy integration.Journal of health economics · 2025Article
- The utility of value frameworks in cost communications: making them real for patients.Journal of the National Cancer Institute · 2024Article
- Designing a Digital Tool to Inform Oncology Practices About Cancer Treatment Cost Burdens.JCO clinical cancer informatics · 2023Article
- Effects of In-office Dispensing by Single-specialty Urology Practices on Management of Advanced Prostate Cancer.Urology practice · 2023Article
- Growing Financial Burden From High-Cost Targeted Oral Anticancer Medicines Among Medicare Beneficiaries With Cancer.JCO oncology practice · 2022Article
- Patient- And Provider-Level Predictors of Survival Among Patients With Metastatic Renal Cell Carcinoma Initiating Oral Anticancer Agents.Clinical genitourinary cancer · 2022Article
- The Oncology Care Model and Adherence to Oral Cancer Drugs: A Difference-in-Differences Analysis.Journal of the National Cancer Institute · 2022Article
- Assessment of patients' understanding of and adherence to oral anticancer medication (OAM): Results of a cross-sectional institutional pilot study.Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners · 2021Article
- Provider- and patient-level predictors of oral anticancer agent initiation and adherence in patients with metastatic renal cell carcinoma.Cancer medicine · 2021Article
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- Survivorship, Version 1.2021.Journal of the National Comprehensive Cancer Network : JNCCN · 2021Article
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- Article
- The Association Between Medicare Low-Income Subsidy and Anticancer Treatment Uptake in Advanced Lung Cancer.Journal of the National Cancer Institute · 2020Article
- Evaluation of Practice Patterns Among Oncologists Participating in the Oncology Care Model.JAMA network open · 2020Article
- Emergency department and inpatient utilization among U.S. older adults with multiple chronic conditions: a post-reform update.BMC health services research · 2020Article
- The Financial Effect of Medicare Coverage Design and Safety Net Options for Cancer Care.Journal of managed care & specialty pharmacy · 2020Article
- Health System and Beneficiary Costs Associated With Intensive End-of-Life Medical Services.JAMA network open · 2019Article
- Can cancer care costs impact quality of life outcomes for the entire household?Psycho-oncology · 2019Article
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
purposeOrally administered anticancer medications are among the fastest growing components of cancer care. These medications are expensive, and cost-sharing requirements for patients can be a barrier to their use. For Medicare beneficiaries, the Affordable Care Act will close the Part D coverage gap (doughnut hole), which will reduce cost sharing from 100% in 2010 to 25% in 2020 for drug spending above $2,960 until the beneficiary reaches $4,700 in out-of-pocket spending. How much these changes will reduce out-of-pocket costs is unclear.
methodsWe used the Medicare July 2014 Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from the Centers for Medicare & Medicaid Services for 1,114 stand-alone and 2,230 Medicare Advantage prescription drug formularies, which represent all formularies in 2014. We identified orally administered anticancer medications and summarized drug costs, cost-sharing designs used by available plans, and the estimated out-of-pocket costs for beneficiaries without low-income subsidies who take a single drug before and after the doughnut hole closes.
resultsLittle variation existed in formulary design across plans and products. The average price per month for included products was $10,060 (range, $5,123 to $16,093). In 2010, median beneficiary annual out-of-pocket costs for a typical treatment duration ranged from $6,456 (interquartile range, $6,433 to $6,482) for dabrafenib to $12,160 (interquartile range, $12,102 to $12,262) for sunitinib. With the assumption that prices remain stable, after the doughnut hole closes, beneficiaries will spend approximately $2,550 less.
conclusionOut-of-pocket costs for Medicare beneficiaries taking orally administered anticancer medications are high and will remain so after the doughnut hole closes. Efforts are needed to improve affordability of high-cost cancer drugs for beneficiaries who need them.
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