Medicaid enrollees appear to be missing out on targeted treatment for NSCLC, Harvard researchers find

1 in 3 Medicaid patients who could have benefited from targeted therapy — primarily Tagrisso and Alecensa — for metastatic lung cancer did not receive it, according to estimates by a trio of Harvard-affiliated researchers.

Approximately 500 people covered by Medicaid did not receive targeted treatment for non-small cell lung cancer (NSCLC), which would likely prolong their lives, according to survey results reported today in Open JAMA network. The researchers estimated that underutilization of targeted therapy—most notably Tagrisso (osimertinib) for NSCLC with targetable EGFR mutations and Alecensa (alectinib) with targetable ALK mutations—resulted in 855 preventable years of life loss during the study period. 2020-2021 study.

Tagrisso and Alecensa use rates varied among the 33 states included in the survey conducted by Thomas J. Roberts, MD, MBA, Aaron S. Kesselheim, MD, JD, MPH, and Jerry Avorn, MD, of the Program on Regulation, Therapeutics and Law at the Harvard-affiliated Brigham and Women’s Hospital in Boston.

According to their calculations, only Massachusetts, Hawaii, and New York had Medicaid populations for which NSCLC-targeted therapies were dispensed in the expected range. Minnesota, Tennessee, Alabama, Georgia and Arkansas ranked lowest.

Overall, their calculations show that about 1 in 3 Medicaid-covered patients with metastatic lung cancer with EGFR and ALK mutations who would have been adequately treated with targeted therapy did not.

“We found evidence of underutilization of targeted therapies for NSCLC among Medicaid recipients and substantial variation in the use of these effective drugs across states,” they concluded. “Where underutilization is confirmed, policymakers should examine state prescribing programs and practices to ensure that patients who need these life-extending drugs can access them.”

Roberts and his colleagues used the Medicaid Drug Utilization Database and IQVIA’s Longitudinal Access and Adjudication Data Set to calculate the number of prescriptions. They calculated the number of people eligible for indirect targeted EGFR and ALK treatment using demographic data on Medicaid populations and prevalence data for NSCLC with EGFR and ALK mutation in these populations; for ALK mutations, they assumed a 3% prevalence of metastatic NSCLC cases for all races and ethnicities.

In the limitations section of the article, they noted that they could not determine the exact number of patients with metastatic NSCLC altered by EGFR and ALK. They also mentioned the limitation that Tagrisso and Alecensa usage data were calculated in aggregate form.

When Roberts, Kesselheim, and Avorn looked for explanations for state-to-state variation, they found that the number of oncologists per 100,000 Medicaid enrollment and Medicaid policies that affected access, such as prior authorization requirements and testing coverage, were factors. But a state’s GDP per capita was the most influential factor in explaining the variation.

“State GDP, the dominant variable in the multivariate model, may be associated with access to these drugs through changes in state budgets and policies or by community characteristics that are correlated with wealth, such as education, community resources, and the rate of smoking,” they wrote.

Medicaid enrollees appear to be missing out on targeted treatment for NSCLC, Harvard researchers find

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