(UroToday.com) During the Society of Urologic Oncology Annual Meeting in Washington, DC, several health policy posters were presented exploring the integral issue of financial toxicity in the care of urologic cancers. Dr. Benjamin Pockros from the University of Michigan presented a study, recently published in Urology Practice, exploring the impact of recent legislation on drug costs for prostate cancer patients.
The Inflation Reduction Act (IRA), enacted on August 16, 2022, included several provisions that aim to significantly reduce prescription drug costs in the U.S. Key features include a new cap on annual out-of-pocket spending for Medicare beneficiaries—$3,250 in 2024 and $2,000 in 2025—and the introduction of Medicare drug price negotiations, a first in history. Dr. Pockros et al explored the financial implications of these policies for patients with advanced prostate cancer, who often face high financial toxicity due to expensive oral medications. The study analyzed cost savings for Medicare Part D insured oral anti-androgen medications like abiraterone, apalutamide, darolutamide, and enzalutamide, using 2021 Medicare Part D data. The authors found that the out-of-pocket spending cap could save patients up to $9,000 annually from 2024.
Starting in 2026, 10 Part D drugs will be subject to price negotiation, expanding to 60 Part D and 35 Part B drugs by 2029. Enzalutamide, costing Medicare $2.4 billion for about 30,000 patients, was identified to be a potential drug that could be first negotiated in 2026, followed by apalutamide and darolutamide in 2027 and 2028, respectively. With over 75,000 patients prescribed oral androgen inhibitors in 2021, and Medicare spending over $4 billion on these, negotiated prices are expected to lead to more than $1 billion in Medicare savings by 2030.
Dr. Kassem Faraj, a urologic oncology fellow at the University of Michigan presented another study also focused on advanced prostate cancer medications, evaluating the impact of the 340B drug pricing program on access and affordability of oral targeted agents like abiraterone and enzalutamide. The 340B program enables eligible hospitals to purchase medications at reduced costs, potentially allowing them to support patients, especially those with socioeconomic disadvantages. Faraj et al. analyzed a 20% sample of national Medicare claims from 2012 to 2019 and found that hospital participation in the 340B program did not significantly influence the initiation of targeted therapy, out-of-pocket costs, or adherence to treatment. Social vulnerability, however, did impact the likelihood of initiating targeted therapy, with men in more vulnerable quintiles being less likely to start treatment. This vulnerability also correlated with higher out-of-pocket costs, though it did not affect adherence.
Lastly, Dr. Daniel Carson presented a study exploring patient experiences and financial implications of telemedicine versus in-person visits for urologic cancer care. A survey assessing satisfaction with care, communication quality, travel time and costs, and workdays missed was administered to a cohort of over 1,000 cancer patients treated at a regional cancer center. Satisfaction rates were high across all visit types, with no significant differences in perceived quality between in-person and telemedicine visits. New in-person visits incurred significantly higher travel costs (average $496.10) compared to telemedicine visits (average $26.70) – the authors noted that many in-person patients required plane travel and hotel stays.
Although limited by its single center nature, the study concluded that telemedicine offers comparable patient satisfaction and markedly lower costs, particularly beneficial for rural-residing patients with urologic cancer. Carson et al. concluded that telemedicine exemptions beyond the COVID-19 related waivers, especially for new patient visits, could continue delivering high-quality care in rural areas.
Presented by: Benjamin Pockros,1 Kassem Faraj,1 & Daniel Carson2
- Department of Urology, University of Michigan
- Department of Urology, University of Washington
Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, during the 2023 Society of Urologic Oncology (SUO) Annual Meeting, Washington, D.C., Tues, Nov 28 – Fri, Dec 1, 2023.