Trends In Antineoplastic Receipt After Medicare Payment Reform: Implications For Future Oncology Payment Design

6513 Background: The Medicare Modernization Act (MMA) changed antineoplastic reimbursement from average wholesale price to average sales price +6%, reducing many outpatient reimbursement rates and altering practice patterns for lung cancer. To further evaluate the MMA’s effect, we focus on colon cancer, where longstanding fluorouracil-based regimens were augmented in 2004 with 3 newly-approved drugs (oxaliplatin, bevacizumab, and/or cetuximab). Methods: Using the 2000-2009 SEER-Medicare data, we examined trends in chemotherapy use and type of antineoplastic received among 59,642 stages II-IV colon cancer patients. Logistic regression models tested the effect of time (pre-post the 2005-2006 reimbursement change) and setting (physician offices implemented reimbursement changes in 2005 vs hospital outpatient departments (OPD) in 2006); interaction terms tested for differential effects of MMA implementation in the 2 settings. Models controlled for patient demographic and tumor characteristics. Results: Overall, 16.3% of stage II, 52.4% stage III and 39.6% stage IV colon cancer patients received antineoplastics. After the reimbursement change in 2007-09 relative to 2000-03, stages II (marginal probability (MP) = -0.06, p < 0.01) and III (MP = -0.04, p < 0.01) patients decreased antineoplastic use, while stage IV patients increased use (MP = 0.03, p < 0.01). While use of fluorouracil-based therapy decreased slightly after reimbursement changes (MP:-0.07 stage II; -0.04 stage III; -0.04 stage IV; p < 0.01 for all), use of new drugs increased substantially (MP: 0.47 stage II; 0.67 stage III, 0.77 stage IV; p < 0.01 for all). Use of new drugs for stage IV cancer occurred earlier in physician offices compared to OPDs (p < 0.01). Conclusions: Colon cancer patients saw small decreases in treatment with fluorouracil-based chemotherapy, but large increases in newly approved drugs after the MMA. Trends suggest slightly earlier increases in physician office settings for stage IV patients, consistent with an MMA effect. The identifiable effects of the MMA are relatively small, but highlight the responsiveness of providers to changes in reimbursement, and the need to integrate new drugs into payment schema.