The use of physician-administered specialty drugs is central to contemporary cancer treatment among the elderly. For the elderly insured under Medicare, physician-administered and some oral anticancer drugs are covered and reimbursed under the Medicare part B program. To generate cost savings, recent policies have aimed to speed up the generic entry of chemotherapy drugs after patent expiration. Yet, the generic entry of irinotecan in February 2008 resulted in a significant 17 to 19 percent decrease in use among the elderly with metastatic colorectal cancer compared with oxaliplatin, a close therapeutic substitute that was still on-patent at the time of irinotecan’s patent expiration, according to a new study.
The researchers believe that declines in the use of irinotecan after patent expiration and generic entry among the elderly may in part be due to how oncologists are reimbursed for the administration of infused chemotherapies. Oncologists make money by acquiring infused or injected chemotherapy at discounted prices, using them to treat patients in the outpatient setting and then billing insurers and patients at a price that is higher than their acquisition price.
Following patent expiration and generic entry, reimbursement by commercial insurers declines immediately and Medicare reimbursement declines with a lag of 6 months. After accounting for other potential reasons for the documented decline in irinotecan use (changes in scientific evidence and drug promotion), the authors suggest estimates by the Centers for Medicare & Medicaid Services Office of Inspector General of the monthly cost savings derived from the generic entry on irinotecan were likely inflated.
This study was supported by AHRQ (HS18535). See "Infused chemotherapy use in the elderly after patent expiration," by Rena M. Conti, Ph.D., Meredith B. Rosenthal, Ph.D., Blasé N. Polite, M.D., and others in the American Journal of Managed Care 18, Special Issue 2, pp. e173-e178, 2012.