title: Patient cost sharing and receipt of erythropoiesis-stimulating agents through medicare part D.
abstract: OBJECTIVE
  Medicare Part D prescription benefits cover injected medications, normally covered under Part B, when administered outside of physician offices. Erythropoiesis-stimulating agents (ESAs) used for chronic anemia management in patients with myelodysplastic syndromes (MDS) are commonly injected in a physician office but can be administered safely at home. In this study, we explored out-of-pocket (OOP) costs and receipt of Part D-covered ESAs in Medicare beneficiaries with MDS.
  
  
  METHODS
  Patients with MDS enrolled in Medicare Parts A, B, and D were identified using diagnosis codes from 100% claims from 2006 to 2008. OOP costs for the mean erythropoietin alfa claim were compared for Parts B and D. Multivariable models examined the effect of low-income subsidy (LIS) and other Part D cost sharing on receipt of any ESA and any Part D-covered ESA.
  
  
  RESULTS
  A total of 13,117 (62.9%) of 20,848 patients received ESAs, but only 1,436 (6.9%) had any Part D claim. OOP payment was $348 under Part D versus $161 under Part B. Among patients with ESA use, those with LIS were 4× more likely to receive Part D ESAs (P < .01).
  
  
  CONCLUSIONS
  Few patients with MDS received ESAs through Part D. OOP payments required under Part D were substantially higher than under Part B. Cost sharing, as reflected by LIS receipt, likely affected decisions to prescribe ESAs outside of the physician office. Improved coordination between Part B and D benefits regarding issues of home injection of medications may create incentives that improve patient access and convenience and reduce costs associated with administration.
authors.affiliation: Yale School of Public Health, Yale University; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Maryland School of Pharmacy; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD; and US Health Outcomes and Medical Policy, GlaxoSmithKline, Durham, NC.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.affiliation: Yale School of Public Health, Yale University; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Maryland School of Pharmacy; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD; and US Health Outcomes and Medical Policy, GlaxoSmithKline, Durham, NC fhend001@umaryland.edu.
authors.forename: Franklin B
authors.initials: FB
authors.lastname: Hendrick
authors.affiliation: Yale School of Public Health, Yale University; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Maryland School of Pharmacy; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD; and US Health Outcomes and Medical Policy, GlaxoSmithKline, Durham, NC.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
authors.affiliation: Yale School of Public Health, Yale University; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Maryland School of Pharmacy; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD; and US Health Outcomes and Medical Policy, GlaxoSmithKline, Durham, NC.
authors.forename: Maria R
authors.initials: MR
authors.lastname: Baer
authors.affiliation: Yale School of Public Health, Yale University; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Maryland School of Pharmacy; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD; and US Health Outcomes and Medical Policy, GlaxoSmithKline, Durham, NC.
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Stuart
authors.affiliation: Yale School of Public Health, Yale University; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Maryland School of Pharmacy; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD; and US Health Outcomes and Medical Policy, GlaxoSmithKline, Durham, NC.
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Shenolikar
authors.affiliation: Yale School of Public Health, Yale University; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Maryland School of Pharmacy; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD; and US Health Outcomes and Medical Policy, GlaxoSmithKline, Durham, NC.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017047:Cost Sharing; D005260:Female; D006397:Hematinics / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016345:Medicare Part B / Q000191:economics; D054524:Medicare Part D / Q000191:economics*; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000191:economics*; D014481:United States
chemical_list: D006397:Hematinics