Study Finds Link Between Medicare Payment Models and Cancer Supplement Prescriptions

Could Medicare payment models impact a physician’s decision to prescribe cancer drug supplements? A recent study from The American Journal of Pharmacy Benefits published new findings that say they can. The AJPB press release states:

A new study from The American Journal of Pharmacy Benefits finds that physicians who treat cancer patients may be influenced by the reimbursement policies of the Medicare claim processors that pay them. The findings also report that bundled payments, wherein all items and services given during an episode of care are paid for in one lump sum, had lower reimbursement amounts than those models that paid doctors separately for each service. This suggests that differences in Medicare reimbursement models can lead to variations in physician care delivery practices.

The study, conducted by West Virginia University researchers Dr. Xiaoyun Pan, and Dr. Usha Sambamoorthi, specifically analyzed non-Hodkin lymphoma (NHL) patients who received granulocyte colony-stimulating factor (G-CSF) as a supplement to their cancer treatment. G-CSF is used to accelerate a patient's recovery from neutropenia after chemotherapy.

“G-CSF is listed as one of the top 10 most expensive Medicare Part B drugs, with average reimbursement amounts for 11 days of supply ranging from $2136 to $3442,” wrote the study authors. “Thus, augmenting chemotherapy with G-CSF may provide increased revenue for the physicians.”

Research findings revealed that G-CSF prescription was less likely in locations with higher physician reimbursement models when compared to those processors with lower average physician reimbursement amounts. While the study did not specifically ask for physicians reasoning in prescribing the supplementary drug, the authors speculate that variation in G-CSF use is likely directly linked with low reimbursement amounts.

The full release can be read here.