Oral Oncology Parity Laws, Medication Use, and Out-of-Pocket Spending for Patients with Blood Cancers

J Natl Cancer Inst. 2019 Dec 27;djz243. doi: 10.1093/jnci/djz243. Online ahead of print.

Abstract

Background: In this study we sought to estimate the association between oral oncology parity law adoption and anticancer medication use for patients with chronic myeloid leukemia (CML) or multiple myeloma.

Methods: This was an observational study of administrative claims from 2008-2017. Among individuals initiating tyrosine kinase inhibitors (TKI) for CML or immunomodulatory drugs for multiple myeloma, we compared out-of-pocket spending, adherence, and discontinuation before and after parity among individuals in fully-insured plans (subject to parity) versus self-funded plans (exempt from parity) using propensity-score weighted difference-in-differences regression models.

Results: Among patients initiating TKIs (N = 2,082) or immunomodulatory drugs (N = 3,326) there were no statistically significant differences in adherence or discontinuation associated with parity. The proportion of patients with initial out-of-pocket payments of $0 increased in fully-insured plans after parity from 5.7% to 46.1% for TKIs and from 10.9% to 48.8% for immunomodulatory drugs. Relative to changes in self-funded plans, those in fully-insured plans were 4.27 (95%CI:2.20-8.27) times as likely to pay nothing for TKIs and 1.96 (95%CI:1.40-2.73) times as likely to pay nothing for immunomodulatory drugs after parity. Similarly, the proportion paying >$100 decreased from 30.3% to 24.7% for TKIs and 30.6% to 27.5% for immunomodulatory drugs in fully-insured plans after parity. Relative to changes in self-funded plans, those in fully-insured plans were 0.74 (95%CI:0.54-1.01) times as likely to pay >$100 for TKIs and 0.85 (95%CI:0.68-1.06) times as likely to pay >$100 for immunomodulatory drugs after parity.

Conclusions: Among patients initiating TKIs or immunomodulatory drugs, parity was not associated with better adherence or less discontinuation of therapy, but yielded decreased patient out-of-pocket payments for some patients.