Volume 131, Issue 7 pp. 1313-1320
RESEARCH ARTICLE

Impact of Reaching the Medicare Part D Drug Benefit Threshold on Surgical Care and Health Outcomes Among Patients Newly Diagnosed With Gastrointestinal Cancer

Eshetu Worku

Eshetu Worku

Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA

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Selamawit Woldesenbet

Selamawit Woldesenbet

Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA

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Mujtaba Khalil

Mujtaba Khalil

Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA

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Timothy M. Pawlik

Corresponding Author

Timothy M. Pawlik

Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA

Correspondence: Timothy M. Pawlik ([email protected])

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First published: 09 January 2025

ABSTRACT

Background

Medicare Part D covers outpatient prescription drugs for elderly beneficiaries, but requires full cost coverage once the coverage gap threshold is reached. We assessed the impact of reaching Medicare Part D threshold on out-of-pocket costs (OOP), timely treatment, and outcomes for patients with gastrointestinal (GI) cancer.

Methods

Individuals newly diagnosed with GI cancer between 2007 and 2019 were identified from the SEER-Medicare database. OOP costs were calculated for the year of diagnosis. Multivariable regression models compared timely surgical care and mortality risk among patients who did and did not reach the coverage gap threshold.

Results

Among 35 745 Medicare beneficiaries diagnosed with colorectal (50.7%), pancreatic (19%), and liver (30.4%) cancer, median age was 76 years (IQR: 71–82), and 56.6% were female. Notably, 48.9% (17 479) of patients reached the Medicare Part D threshold in the year of cancer diagnosis. Mean OOP cost for patients who reached the threshold was $1060 (SD: $1417) vs. $268 (SD: $270, p < 0.0001) for individuals who did not. On multivariable analysis, patients who reached the threshold were more likely to delay [OR: 1.13, 95% CI: 1.03–1.24] or not receive surgery [OR: 1.40, 95% CI: 1.27–1.54], and had a higher risk of 5-year mortality [HR 5-year: 1.12, 95% CI: 1.09–1.15, p < 0.0001] regardless of comorbidity status, cancer site, and disease stage.

Conclusion

Reaching the coverage gap threshold was associated with delayed or non receipt of surgical treatment, which resulted in increased long-term mortality. Lowering the Part D threshold through policy adjustments may reduce financial strain and improve health outcomes for cancer patients.

Summary

  • Reaching the Medicare Part D coverage gap threshold resulted in delayed or non receipt of surgical treatment for gastrointestinal cancer, which was associated with increased long-term mortality.

  • Lowering the Part D threshold through policy adjustments may reduce financial strain and improve health outcomes for patients with GI cancers.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data for this study were obtained from the Medicare database. There are restrictions to the availability of this data, which is used under license for this study. Data can be accessed with permission from the Centers for Medicare and Medicaid Services.

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