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Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer.

Publication ,  Journal Article
Kaye, DR; Lee, H-J; Gordee, A; George, DJ; Ubel, PA; Scales, CD; Bundorf, MK
Published in: JCO oncology practice
April 2023

The implications of high prices for cancer drugs on health care costs and patients' financial burdens are a growing concern. Patients with metastatic castrate-resistant prostate cancer (mCRPC) are often candidates for multiple first-line systemic therapies with similar impacts on life expectancy. However, little is known about the gross and out-of-pocket (OOP) payments associated with each of these drugs for patients with employer-sponsored health insurance. We therefore aimed to determine the gross and OOP payments of first-line drugs for mCRPC and how the payments vary across drugs.This retrospective cohort study included 4,298 patients with prostate cancer who initiated therapy with one of six drugs approved for first-line treatment of mCRPC between July 1, 2013, and June 30, 2019. We compared gross and OOP payments during the 6 months after initiation of treatment for mCRPC using private payer claims data across patients using different first-line drugs.Gross payments varied across drugs. Over the 6 months after the index prescription, mean unadjusted gross drug payments were highest for patients receiving sipuleucel-T ($115,525 USD) and lowest for patients using docetaxel ($12,804 USD). OOP payments were lower than gross drug payments; mean 6-month OOP payments were highest for cabazitaxel ($1,044 USD) and lowest for docetaxel ($296 USD). There was a wide distribution of OOP payments within drug types.Drugs for mCRPC are expensive with large differences in payments by drug type. OOP payments among patients with employer-sponsored health insurance are much lower than gross drug payments, and they vary both across and within first-line drug types, with some patients making very high OOP payments. Although lowering drug prices would reduce pharmaceutical spending for patients with mCRPC, decreasing patient financial burden requires understanding an individual patient's benefit design.

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Published In

JCO oncology practice

DOI

EISSN

2688-1535

ISSN

2688-1527

Publication Date

April 2023

Volume

19

Issue

4

Start / End Page

e600 / e617

Related Subject Headings

  • Retrospective Studies
  • Prostatic Neoplasms, Castration-Resistant
  • Male
  • Insurance Carriers
  • Humans
  • Health Care Costs
  • Docetaxel
  • 3211 Oncology and carcinogenesis
 

Citation

APA
Chicago
ICMJE
MLA
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Kaye, D. R., Lee, H.-J., Gordee, A., George, D. J., Ubel, P. A., Scales, C. D., & Bundorf, M. K. (2023). Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer. JCO Oncology Practice, 19(4), e600–e617. https://doi.org/10.1200/op.22.00645
Kaye, Deborah R., Hui-Jie Lee, Alexander Gordee, Daniel J. George, Peter A. Ubel, Charles D. Scales, and M Kate Bundorf. “Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer.JCO Oncology Practice 19, no. 4 (April 2023): e600–617. https://doi.org/10.1200/op.22.00645.
Kaye DR, Lee H-J, Gordee A, George DJ, Ubel PA, Scales CD, et al. Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer. JCO oncology practice. 2023 Apr;19(4):e600–17.
Kaye, Deborah R., et al. “Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer.JCO Oncology Practice, vol. 19, no. 4, Apr. 2023, pp. e600–17. Epmc, doi:10.1200/op.22.00645.
Kaye DR, Lee H-J, Gordee A, George DJ, Ubel PA, Scales CD, Bundorf MK. Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer. JCO oncology practice. 2023 Apr;19(4):e600–e617.

Published In

JCO oncology practice

DOI

EISSN

2688-1535

ISSN

2688-1527

Publication Date

April 2023

Volume

19

Issue

4

Start / End Page

e600 / e617

Related Subject Headings

  • Retrospective Studies
  • Prostatic Neoplasms, Castration-Resistant
  • Male
  • Insurance Carriers
  • Humans
  • Health Care Costs
  • Docetaxel
  • 3211 Oncology and carcinogenesis