ArticleJournal of the National Cancer Institute2020
The Association Between Medicare Low-Income Subsidy and Anticancer Treatment Uptake in Advanced Lung Cancer.
Article in Journal of the National Cancer Institute, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- Genomic Testing Uptake Among Medicare Beneficiaries With Cancer.JAMA network open · 2026Article
- Individual and combined effects of marital status, household income, and residence on cancer management and survival in primary bone cancer: a SEER-based retrospective cohort study.Translational cancer research · 2026Article
- Potential Impact of the Medicare Prescription Payment Plan for Medicare Part D Beneficiaries With a Cancer Diagnosis.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026Article
- Quality of Treatment Selection for Medicare Beneficiaries With Cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2025Article
- Closing the Gap: Evaluating Medicare's Low-Income Subsidy Support for Optimal Cancer Care.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2025Article
- The high costs of anticancer therapies in the USA: challenges, opportunities and progress.Nature reviews. Clinical oncology · 2024Review
- Article
- The State of Use and Utility of Negative Controls in Pharmacoepidemiologic Studies.American journal of epidemiology · 2024Review
- Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.The American journal of managed care · 2023Article
- Extra Help Needs a Hand: Partial Subsidies in the Medicare Part D Program.Journal of general internal medicine · 2022Article
- Factors associated with medication nonadherence among Medicare low-income subsidy beneficiaries with diabetes, hypertension, and/or heart failure.Journal of managed care & specialty pharmacy · 2021Article
- Sociodemographic disparities in the management of advanced lung cancer: a narrative review.Journal of thoracic disease · 2021Review
- Time to add screening for financial hardship as a quality measure?CA: a cancer journal for clinicians · 2021Article
- The Public Health Insurance Coverage of Novel Targeted Anticancer Medicines in China-In Favor of Whom? A Retrospective Analysis of the Insurance Claim Data.Frontiers in pharmacology · 2021Article
- Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundHigh out-of-pocket costs may impact anticancer treatment uptake. The Low-Income Subsidy (LIS) program can reduce patient out-of-pocket cost for Medicare Part D-covered treatments. We examined whether the LIS increased uptake and reduced time to initiate orally administered anticancer drugs in patients with advanced non-small cell lung cancer (NSCLC).
methodsUsing Surveillance, Epidemiology and End Results (SEER)-Medicare data, we identified older adults (aged 65 years and older) diagnosed with advanced NSCLC from 2007 through 2013 and categorized them as full LIS, partial LIS, or non-LIS. We used propensity-score weighted (IPTW) Cox proportional hazards regression to assess the likelihood of and time to initiate Part D treatments. Part B medication uptake was our negative control because supplemental insurance reduces out-of-pocket costs for those drugs. All statistical tests were two-sided.
resultsAmong 19 746 advanced NSCLC patients, approximately 10% initiated Part D treatments. Patients with partial or no LIS were less likely to initiate Part D treatments than were those with full subsidies (partial LIS vs full LIS HRIPTW = 0.77, 95% confidence interval = 0.62 to 0.97; non-LIS vs full LIS HRIPTW = 0.87, 95% confidence interval = 0.79 to 0.95). Time to initiate Part D treatments was also slightly shorter among full-LIS patients (full LIS mean [SD] = 10.8 [0.04] months; partial LIS mean [SD] = 11.3 [0.08] months; and non-LIS mean [SD] = 11.1 [0.03] months, P < .001). Conversely, patients with partial or no LIS had shorter time to initiation of Part B drugs.
conclusionsPatients receiving the full LIS had higher orally administered anticancer treatment uptake than patients without LIS. Notably, patients with partial LIS had the lowest treatment uptake, likely because of their low incomes combined with high expected out-of-pocket spending. High out-of-pocket costs for Part D medications may be a barrier to treatment use for patients without full LIS.
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