Medicare Advantage Plans Inadvertently Reduce Clinical Trial Enrollment

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Researchers from the University of Pittsburgh Cancer Institute noted that the number of elderly patients with a new cancer diagnosis enrolled in oncology clinical trials has declined, and they think Medicare Advantage may be to blame. The researchers note that although Medicare beneficiaries make up two-thirds of all patients with cancer, less than one-third enroll in clinical trials.

Lin et al examined records for patients who received a diagnosis of cancer at a consortium of Western Pennsylvania hospitals in 2003-2007. They found that in 2007, 27% of patients had medical coverage through a health maintenance organization as part of the Medicare Advantage program, a 7% increase from 2003. The study found that 103 elderly patients undergoing treatment at Western Pennsylvania in 2007 cited concerns about cost as their reason for not enrolling in available clinical trials. In considering 4 clinical trials available to cancer patients, researchers determined that patients in a Medicare HMO would have to pay between $113 to $3083 per month to participate, depending on the trial.

Although Medicare’s general policy encourages subscribers to participate in oncology trials, patients in Medicare Advantage plans appear to have higher out-of-pocket costs for clinical trial participation than those enrolled in the conventional Medicare fee-for-service program. The National Cancer Institute believes that clinical trial participation must be a national priority if the United States is to evaluate and improve the effectiveness and safety of available therapies and develop new ones. Chyongchio Lin, PhD, the study’s lead author, noted that “clinical trials are the cornerstone in finding better, more effective cancer treatments.” She added that Medicare’s current reimbursement policies exclude large numbers of patients from “cutting-edge treatments” and recommended that “the current policy…be reexamined to be consistent with National Cancer Institute initiatives.”

Lin C, Heron DE. Does Medicare HMO reimbursement policy hinder clinical trial participation? Poster presented at: 50th Annual Meeting of the American Society for Therapeutic Radiology and Oncology; September 2008; Boston, MA.