Trends in patient copays for hospital and office-based chemotherapy 2005-2012 for Medicare and commercially insured patients.

Abstract

260 Background: With the growing shift towards chemotherapy administration in outpatient hospital settings (OHS) versus office-based settings (OBS), we sought to characterize the percent of patients with a copay and the mean copayment by setting and insurance type over time. Methods: Using the MarketScan Research Databases, first administrations of bevacizumab and trastuzumab were identified from 1/1/2005 through 12/31/2012 for patients with commercial or employer-sponsored supplemental Medicare insurance. Bevacizumab claims were excluded if the claim had a diagnosis related to macular degeneration or other eye disease. All claims were identified in OHS, OBS, or other setting. Results: The percent of patients with a copayment varied by insurer and setting but within each group remained fairly consistent over time. The average percent with a copay was 14% OHS and 19% OBS for commercial and 17% OHS and 28% OBS for Medicare patients. Per administration copayment amounts varied over time, with peaks of $978 OHS and $631 OBS for commercial in 2012 and $721 OHS and $464 OBS in 2011 for Medicare with 2012 Medicare copayments declining somewhat for bevacizumab. For herceptin peak mean copayments were $886 and $439 in 2012 for OHS and OBS commercial patients, respectively, and $458 and $474 in 2010 with declines in 2011 and 2012 for Medicare, respectively. Commercial patients receiving care in OHS settings consistently faced copayments that were 50 to 100% higher those paid by patients receiving chemotherapy in OBS. Copayment differentials were smaller for Medicare patients. Conclusions: As more patients are receiving care in OHS, these data imply significant financial burdens on patients, especially for those with commercial health insurance. Additional research is necessary to understand the overall cost burden on patients and whether the shift to OHS-based care has negatively impacted patient adherence or quality of life due to financial burden. [Table: see text]