• Mayo Clinic proceedings · Dec 2023

    Analysis of Medicare Expenditure for Discarded Infused Cancer Therapeutics From 2017-2020.

    • Aakash Desai, Alexander Xiao, Caleb Smith, Chelsee Jensen, Joshua Pritchett, Scott Soefje, Urshila Durani, Ronald Go, Caleb Scheckel, and Hematology Oncology Outcomes Research Group.
    • Division of Hematology, Mayo Clinic, Rochester, MN, USA; Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
    • Mayo Clin. Proc. 2023 Dec 1; 98 (12): 176717731767-1773.

    ObjectiveTo explore patterns in Medicare reimbursement for wasted oncologic and hematologic infusion drugs from 2017 to 2020 and estimate the savings that implementation of the Infrastructure Investment and Jobs Act (IIJA) would have had.MethodsUsing the publicly available Medicare Part B Discarded Drug Units database, we analyzed reimbursement data for discarded antineoplastic and hematology therapies from 2017 to 2020.ResultsMedicare Part B utilization data was extracted for 77 therapies. From 2017 to 2020, the median annual dollar value of discarded therapies was $590 million. Every year, bortezomib, azacitidine, cabazitaxel, and decitabine were among the most wasted products, an average 24% waste. The IIJA policy would have impacted a median of 20 oncology agents and resulted in median annual refund of $172 million. Had the top five most discarded therapies been redistributed, they could have treated 18,289 patients. The five most wasted drugs were all dosed by weight and distributed in single-use vials.ConclusionThe IIJA could potentially significantly reduce waste or encourage redistribution to treat thousands of additional patients. We propose that a fusion of fixed and weight-based dosing may help reduce wasteful medication administration by offering doses that better accommodate most patients. We anticipate that manufacturers will adapt to the IIJA perhaps by adjusting fixed doses or simply increasing drug prices. If price changes from dose delivery adjustment occur, rebates offered to pharmacy benefit managers and insurers will likely follow suit and may alter formulary positioning.Copyright © 2023. Published by Elsevier Inc.

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