Changes in oncology pharmacy benefit drug spend and trend in the United States.

Abstract

e18832 Background: The American Cancer Society projects the total cost of cancer care to increase to approximately $246 billion by 2030, an increase of roughly 34% from 2015. Estimating the nature and extent of health care spending on cancer care is vital to understanding the scope of cancer costs. Additionally, this information will help inform the development of policies and programs to optimize the value of cancer care. The purpose of this study is to evaluate changes in oncology-pharmacy benefit (PB) spend and highlight areas that may be targets for value improvement. Methods: We identified patients with cancer using medical claims data from January 1, 2019, to December 31, 2020 at a large national Medicaid, Medicare, and commercial insurer. We defined total oncology spend (TOS) as the sum of allowed costs paid for medical and pharmacy claims per year, including chemotherapy, supportive therapy, radiology, radiation, emergency room, inpatient admission and evaluation and management. We compared the total oncology spend, by type of service, for each year by cancer for patients receiving therapies paid under the PB. Results: This study included 72,923 patients in 2019 and 52,486 patients in 2020. During this time, the top 3 disease states with the highest percent of oncology spend attributed to PB were chronic myeloid leukemia (CML), multiple myeloma (MM) and chronic lymphocytic leukemia (CLL). Approximately 87% and 77% of total oncology spend were attributed to PB chemotherapy among CML and MM patients, respectively. CLL costs varied by type of insurance with 80%, 26% and 19% of the total oncology spend attributed to PB chemotherapy in Medicare, fully insured and self-insured patients, respectively. When examining year-over-year changes in PB spend from 2019 to 2020, we observed an increase in total oncology spend in gynecologic cancers regardless of the type of insurance. Additionally, we observed increases in rectal, gastric, head and neck cancers and hepatobiliary cancers primarily driven by Medicare patients. Conclusions: The economic burden of cancer is substantial and expected to significantly increase in the future. In this study, we observed differences in total oncology spend by cancer type and insurance, a proxy for age. Identifying trends in cancer spending allows the development of programs designed to better optimize value for certain tumor types.[Table: see text]