Use of Low-Value Cancer Treatments in Medicare Advantage Versus Traditional Medicare.

Abstract

Purpose: Medicare Advantage (MA) provides beneficiaries an option to receive Medicare benefits from private plans. Although MA covers over half of the Medicare population, limited information exists about how utilization of cancer treatments in MA differs from traditional Medicare (TM). We compared use of low-value cancer treatments between MA and TM and analyzed variation in use of low-value cancer treatments across large MA insurers.

Methods: Using national Medicare data, we performed retrospective analyses of beneficiaries who had a new cancer diagnosis between 2016 and 2021 and who were at risk of receiving a low-value treatment: granulocyte-colony stimulating factors (GCSFs) for patients receiving low-risk chemotherapy, denosumab for castration-sensitive prostate cancer (CSPC), nab-paclitaxel instead of paclitaxel for breast or lung cancers, adding bevacizumab to carboplatin plus paclitaxel for ovarian cancer, and branded drugs or biologics for which generic or biosimilar versions existed.

Results: Use of any low-value cancer treatment was 1.7 percentage points lower in MA than in TM (34.2% v 35.9%; P < .001). MA had lower utilization rates than TM for GCSF among patients receiving low-risk chemotherapy (7.3% v 8.9%; P < .001), denosumab for CSPC (26.4% v 33.1%; P < .001), nab-paclitaxel for breast or lung cancer (7.9% v 8.7%; P < .001), addition of bevacizumab for ovarian cancer (8.3% v 10.5%; P < .001), and biologics with biosimilar alternatives (66.8% v 68.5%; P < .001). Use of branded drugs did not significantly differ between MA and TM. The differences in use of low-value cancer treatments from TM varied moderately across large MA insurers.

Conclusion: MA has lower use of low-value cancer treatments than TM, with varying degrees across large MA insurers. Efforts are needed to identify effective strategies to reduce use of low-value cancer treatments.