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Cost sharing for breast cancer hormone therapy: How do dual eligible patients’ copayment impact adherence

OBJECTIVE: To examine the different levels of copayment assistance and treatment adherence among Medicare and Medicaid dual eligible beneficiaries with breast cancer in the U.S. RESEARCH DESIGN: Propensity Score methodology was adopted to minimize potential selection bias from the nonrandom allocati...

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Autores principales: Ma, Siyu, Shepard, Donald S., Ritter, Grant A., Martell, Robert E., Thomas, Cindy Parks
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130966/
https://www.ncbi.nlm.nih.gov/pubmed/34003865
http://dx.doi.org/10.1371/journal.pone.0250967
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author Ma, Siyu
Shepard, Donald S.
Ritter, Grant A.
Martell, Robert E.
Thomas, Cindy Parks
author_facet Ma, Siyu
Shepard, Donald S.
Ritter, Grant A.
Martell, Robert E.
Thomas, Cindy Parks
author_sort Ma, Siyu
collection PubMed
description OBJECTIVE: To examine the different levels of copayment assistance and treatment adherence among Medicare and Medicaid dual eligible beneficiaries with breast cancer in the U.S. RESEARCH DESIGN: Propensity Score methodology was adopted to minimize potential selection bias from the nonrandom allocation of the treatment group (i.e., full Medicaid beneficiaries) and control group (i.e., Medicare Savings Programs [MSPs] beneficiaries). Longitudinal hierarchical model and Cox proportional-hazard model were adopted to examine patients’ adherence over their full five-year course of adjuvant hormone therapy. RESULTS: Our study cohort consisted of 1,133 dual eligible beneficiaries diagnosed with hormone receptor-positive early stage breast cancer in years 2007 –mid 2009. About 80.5% of them received MSPs benefits, while the rest received full Medicaid benefits. On average for a standardized 30-day hormone therapy medication, full Medicaid beneficiaries spent $0.5-$2.0 and MSP beneficiaries spent $1.4-$4.8 in copayment. After adjusting for other factors, this copayment reduction wasn’t associated with a significantly better adherence. However, when the catastrophic coverage threshold was reached (copayments reduced to zero), significant improvement in adherence was found in both groups. CONCLUSIONS: Our study found that small amount of cost-sharing reduction did not affect Medicare and Medicaid dual eligible patients’ medication treatment adherence, however, the elimination of cost-sharing (even a minimal amount) was associated with improved adherence. Future legislative and advocacy efforts should be paid on eliminating cost sharing for dual eligibles, and possibly even a broader group of financially vulnerable patients.
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spelling pubmed-81309662021-05-27 Cost sharing for breast cancer hormone therapy: How do dual eligible patients’ copayment impact adherence Ma, Siyu Shepard, Donald S. Ritter, Grant A. Martell, Robert E. Thomas, Cindy Parks PLoS One Research Article OBJECTIVE: To examine the different levels of copayment assistance and treatment adherence among Medicare and Medicaid dual eligible beneficiaries with breast cancer in the U.S. RESEARCH DESIGN: Propensity Score methodology was adopted to minimize potential selection bias from the nonrandom allocation of the treatment group (i.e., full Medicaid beneficiaries) and control group (i.e., Medicare Savings Programs [MSPs] beneficiaries). Longitudinal hierarchical model and Cox proportional-hazard model were adopted to examine patients’ adherence over their full five-year course of adjuvant hormone therapy. RESULTS: Our study cohort consisted of 1,133 dual eligible beneficiaries diagnosed with hormone receptor-positive early stage breast cancer in years 2007 –mid 2009. About 80.5% of them received MSPs benefits, while the rest received full Medicaid benefits. On average for a standardized 30-day hormone therapy medication, full Medicaid beneficiaries spent $0.5-$2.0 and MSP beneficiaries spent $1.4-$4.8 in copayment. After adjusting for other factors, this copayment reduction wasn’t associated with a significantly better adherence. However, when the catastrophic coverage threshold was reached (copayments reduced to zero), significant improvement in adherence was found in both groups. CONCLUSIONS: Our study found that small amount of cost-sharing reduction did not affect Medicare and Medicaid dual eligible patients’ medication treatment adherence, however, the elimination of cost-sharing (even a minimal amount) was associated with improved adherence. Future legislative and advocacy efforts should be paid on eliminating cost sharing for dual eligibles, and possibly even a broader group of financially vulnerable patients. Public Library of Science 2021-05-18 /pmc/articles/PMC8130966/ /pubmed/34003865 http://dx.doi.org/10.1371/journal.pone.0250967 Text en © 2021 Ma et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Ma, Siyu
Shepard, Donald S.
Ritter, Grant A.
Martell, Robert E.
Thomas, Cindy Parks
Cost sharing for breast cancer hormone therapy: How do dual eligible patients’ copayment impact adherence
title Cost sharing for breast cancer hormone therapy: How do dual eligible patients’ copayment impact adherence
title_full Cost sharing for breast cancer hormone therapy: How do dual eligible patients’ copayment impact adherence
title_fullStr Cost sharing for breast cancer hormone therapy: How do dual eligible patients’ copayment impact adherence
title_full_unstemmed Cost sharing for breast cancer hormone therapy: How do dual eligible patients’ copayment impact adherence
title_short Cost sharing for breast cancer hormone therapy: How do dual eligible patients’ copayment impact adherence
title_sort cost sharing for breast cancer hormone therapy: how do dual eligible patients’ copayment impact adherence
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130966/
https://www.ncbi.nlm.nih.gov/pubmed/34003865
http://dx.doi.org/10.1371/journal.pone.0250967
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