How did Part D affect mortality among women with breast cancer?

By | March 2, 2017

pink ribbon graphicTen years ago, Medicare began publicly financing and subsidizing the prescription drug program for seniors known as Part D. Individuals over age 65 with incomes below poverty are dually eligible for both Medicaid and Medicare, and full-benefit dual enrollees are automatically enrolled in a subsidized prescription drug plan with minimal co-payments. Turns out, this policy intervention may have played a part in saving the lives of thousands of women over the past decade.

The study, published ahead-of-print in Medical Care this month, was conducted by a team of researchers from the University of Wisconsin led by Dr. Ann Nattinger. They used Medicare and National Death Index data from 2001 (N= 54,772) and 2007 (N= 46,371) to study all-cause and breast-cancer specific mortality and identify the effect attributable to Part D after adjusting for typical confounders and accounting for trends over the study time period.

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Adapted from data in Nattinger et al, Med Care PAP December 27, 2016; doi: 10.1097/MLR.0000000000000685

In human terms, the data suggest that, among those diagnosed in 2007 (after Part D began), 6,602 fewer dual enrollees and 10,472 fewer other women died within 5 years of diagnosis. Other things besides Part D may explain the better survival in the later cohort, including differences in stage at diagnosis (which the researchers were unable to measure using their data), changes in breast cancer treatment over time, or better management of other illnesses. The overall death rate [PDF] has also been declining over time in the US. So, it’s hard to say exactly how much of a role Part D played, especially since the researchers didn’t separate the cohort of women diagnosed post-Part D by enrollment status.

Nevertheless, according to data from the Medical Expenditure Panel Survey (MEPS) collected between 1996 and 2005, 57% of Medicare beneficiaries over age 65 with cancer had annual out-of-pocket costs exceeding 10% of their annual income. When costs get that high, cancer patients start having to make trade-offs between paying for heat or food or medicine. That’s why subsidizing drug coverage may be part of the solution for addressing socioeconomic disparities in mortality among women with breast cancer, especially the poorest.

This study underscores the importance of access to affordable care for all. Disparities won’t go away on their own, but policy interventions really can work to save lives.

Lisa Lines

Lisa Lines

Health services researcher at RTI International
Lisa M. Lines, PhD, MPH is a health services researcher at RTI International, an independent, non-profit research institute. She is also an Instructor in Quantitative Health Sciences at the University of Massachusetts Medical School. Her research focuses on quality of care, care experiences, and health outcomes among people with chronic illnesses; emergency department utilization; and person-centered care and patient-centered medical homes, among other topics. She is co-editor of TheMedicalCareBlog.com and serves on the Medical Care Editorial Board. She also serves as chair of the APHA Medical Care Section's Health Equity Committee. In 2015, Dr. Lines was appointed to a 3-year term on the National Quality Forum's Neurology Standing Committee. Views expressed are the author's and do not necessarily reflect those of RTI or UMass Medical School.
Lisa Lines
Lisa Lines

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About Lisa Lines

Lisa M. Lines, PhD, MPH is a health services researcher at RTI International, an independent, non-profit research institute. She is also an Instructor in Quantitative Health Sciences at the University of Massachusetts Medical School. Her research focuses on quality of care, care experiences, and health outcomes among people with chronic illnesses; emergency department utilization; and person-centered care and patient-centered medical homes, among other topics. She is co-editor of TheMedicalCareBlog.com and serves on the Medical Care Editorial Board. She also serves as chair of the APHA Medical Care Section's Health Equity Committee. In 2015, Dr. Lines was appointed to a 3-year term on the National Quality Forum's Neurology Standing Committee. Views expressed are the author's and do not necessarily reflect those of RTI or UMass Medical School.