Disparities in Multiple Myeloma Treatment: Medicare Advantage vs. Traditional Medicare

Research published in JCO Oncology Practice highlights a significant discrepancy in the administration of combination therapies for multiple myeloma between patients with Medicare Advantage (MA) and those with traditional Medicare (TM) coverage. Although combination therapies are the standard care for multiple myeloma, this study calls for a deeper exploration into the disparity in treatment outcomes among different Medicare beneficiaries.

For over a decade, regimens including bortezomib, lenalidomide, and dexamethasone have been the benchmark for multiple myeloma treatment, along with other effective combinations like carfilzomib, lenalidomide, and dexamethasone. Despite their effectiveness, these high-cost therapies can amount to $600,000 annually per patient. Medicare typically covers these expenses, but both MA and TM plans implement cost-sharing and utilization management strategies, which may influence patient access.

Prior studies have shown a tendency among Medicare Advantage-covered patients to initiate anticancer treatments less frequently than those under Traditional Medicare. Despite this, specific research focusing on the differences in multiple myeloma therapy initiation between MA and TM coverage has been lacking until now.

Study Findings on Treatment Initiation

The study analyzed data from the Surveillance, Epidemiology, and End Results Program, assessing treatment initiation among multiple myeloma patients under MA versus TM. The sample included 8,484 TM patients and 6,565 MA patients. Notably, there was a demographic alignment, with similar age and gender distribution among both groups. However, 73.77% of TM patients were non-Hispanic White compared to 51.07% of MA patients, and low-income subsidies were received by 18.41% of TM beneficiaries versus 20.26% of those with MA.

The initiation rate for multiple myeloma therapy stood at 74.65% for MA patients versus 73.22% for TM patients. Nevertheless, a greater number of TM patients commenced combination therapies—52.45% compared to 48.64% for those with MA. MA patients were more likely to start self-administered therapies rather than clinician-administered ones, reflecting an adjusted risk ratio of 1.16. There was also a reduced likelihood for MA patients to initiate combination therapies compared to self-administered options, shown by an adjusted risk ratio of 0.93.

Future Research Directions

The authors stress the necessity for further research, especially as Medicare Advantage enrollment is projected to exceed two-thirds of all beneficiaries by 2034. Future studies should focus on how provider networks, utilization management practices, and changing prescription drug benefits influence treatment accessibility, quality, and affordability for multiple myeloma and broader cancer care.

This research received support from Blood Cancer United, with a complete disclosure list available in the original reference.