title: Did changes in drug reimbursement after the medicare modernization act affect chemotherapy prescribing?
abstract: OBJECTIVE
  The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) decreased fee-for-service (FFS) payments for outpatient chemotherapy. We assessed how this policy affected chemotherapy in FFS settings versus in integrated health networks (IHNs).
  
  
  METHODS
  We examined 5,831 chemotherapy regimens for 3,613 patients from 2003 to 2006 with colorectal cancer (CRC) or lung cancers in the Cancer Care Outcomes Research Surveillance Consortium. Patients were from four geographically defined regions, seven large health maintenance organizations, and 15 Veterans Affairs Medical Centers. The outcome of interest was receipt of chemotherapy that included at least one drug for which reimbursement declined after the MMA.
  
  
  RESULTS
  The odds of receiving an MMA-affected drug were lower in the post-MMA era: the odds ratio (OR) was 0.73 (95% CI, 0.59 to 0.89). Important differences across cancers were detected: for CRC, the OR was 0.65 (95% CI, 0.46 to 0.92); for non-small-cell lung cancer (NSCLC), the OR was 1.60 (95% CI, 1.09 to 2.35); and for small-cell lung cancer, the OR was 0.63 (95% CI, 0.34 to 1.16). After the MMA, FFS patients were less likely to receive MMA-affected drugs: OR, 0.73 (95% CI, 0.59 to 0.89). No pre- versus post-MMA difference in the use of MMA-affected drugs was detected among IHN patients: OR, 1.01 (95% CI, 0.66 to 1.56). Patients with CRC were less likely to receive an MMA-affected drug in both FFS and IHN settings in the post- versus pre-MMA era, whereas patients with NSCLC were the opposite: OR, 1.60 (95% CI, 1.09 to 2.35) for FFS and 6.33 (95% CI, 2.09 to 19.11) for IHNs post- versus pre-MMA.
  
  
  CONCLUSIONS
  Changes in reimbursement after the passage of MMA appear to have had less of an impact on prescribing patterns in FFS settings than the introduction of new drugs and clinical evidence as well as other factors driving adoption of new practice patterns.
authors.affiliation: Mark C. Hornbrook, Kaiser Permanente Northwest, Portland, OR; Jennifer Malin, Veterans Affairs Medical Center and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA; Jane C. Weeks and Nancy L. Keating, Harvard Medical School; Jane C. Weeks, Dana-Farber Cancer Institute; Nancy L. Keating, Brigham and Women's Hospital, Boston MA; and Solomon B. Makgoeng and Arnold L. Potosky, Georgetown University Medical Center, Washington, DC. mark.c.hornbrook@kpchr.org.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.affiliation: Mark C. Hornbrook, Kaiser Permanente Northwest, Portland, OR; Jennifer Malin, Veterans Affairs Medical Center and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA; Jane C. Weeks and Nancy L. Keating, Harvard Medical School; Jane C. Weeks, Dana-Farber Cancer Institute; Nancy L. Keating, Brigham and Women's Hospital, Boston MA; and Solomon B. Makgoeng and Arnold L. Potosky, Georgetown University Medical Center, Washington, DC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.affiliation: Mark C. Hornbrook, Kaiser Permanente Northwest, Portland, OR; Jennifer Malin, Veterans Affairs Medical Center and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA; Jane C. Weeks and Nancy L. Keating, Harvard Medical School; Jane C. Weeks, Dana-Farber Cancer Institute; Nancy L. Keating, Brigham and Women's Hospital, Boston MA; and Solomon B. Makgoeng and Arnold L. Potosky, Georgetown University Medical Center, Washington, DC.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.affiliation: Mark C. Hornbrook, Kaiser Permanente Northwest, Portland, OR; Jennifer Malin, Veterans Affairs Medical Center and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA; Jane C. Weeks and Nancy L. Keating, Harvard Medical School; Jane C. Weeks, Dana-Farber Cancer Institute; Nancy L. Keating, Brigham and Women's Hospital, Boston MA; and Solomon B. Makgoeng and Arnold L. Potosky, Georgetown University Medical Center, Washington, DC.
authors.forename: Solomon B
authors.initials: SB
authors.lastname: Makgoeng
authors.affiliation: Mark C. Hornbrook, Kaiser Permanente Northwest, Portland, OR; Jennifer Malin, Veterans Affairs Medical Center and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA; Jane C. Weeks and Nancy L. Keating, Harvard Medical School; Jane C. Weeks, Dana-Farber Cancer Institute; Nancy L. Keating, Brigham and Women's Hospital, Boston MA; and Solomon B. Makgoeng and Arnold L. Potosky, Georgetown University Medical Center, Washington, DC.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.affiliation: Mark C. Hornbrook, Kaiser Permanente Northwest, Portland, OR; Jennifer Malin, Veterans Affairs Medical Center and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA; Jane C. Weeks and Nancy L. Keating, Harvard Medical School; Jane C. Weeks, Dana-Farber Cancer Institute; Nancy L. Keating, Brigham and Women's Hospital, Boston MA; and Solomon B. Makgoeng and Arnold L. Potosky, Georgetown University Medical Center, Washington, DC.
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics; D019033:Delivery of Health Care, Integrated; D004363:Drug Utilization; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics; D008297:Male; D054524:Medicare Part D / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D055553:Prescription Drugs / Q000191:economics / Q000627:therapeutic use*; D012051:Reimbursement Mechanisms; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D055553:Prescription Drugs