Differences in Antimyeloma Treatment Between Medicare Advantage and Traditional Medicare Beneficiaries

PURPOSE Self- and clinician-administered combination therapy is the standard of care for multiple myeloma. Unlike traditional Medicare (TM), Medicare Advantage (MA) plans use utilization management for clinician-administered drugs, which could limit access to these novel regimens. Our objectives were to assess differences in the initiation and type of antimyeloma treatment between MA and TM beneficiaries. METHODS We used the SEER-Medicare–linked database to identify and classify initial antimyeloma treatment into one of the following mutually exclusive categories: self-administered, clinician-administered, or combination of self- and clinician-administered. We used modified Poisson regression models to assess the probability of initiating antimyeloma treatment in the 12 months after diagnosis and, among those treated, the likelihood of starting specific types of treatment (eg, combination v self-administered). RESULTS Among the 15,049 beneficiaries studied, 43.6% were enrolled in MA. Initiation of antimyeloma treatment was similar between MA (74.65%) and TM (73.22%) beneficiaries; however, a larger proportion of TM beneficiaries started combination therapy relative to their MA counterparts (52.45% v 48.64%). Type of Medicare coverage was not associated with antimyeloma treatment initiation (adjusted risk ratio aRR, 1.02 95% CI, 1 to 1.04). Compared with TM beneficiaries, MA beneficiaries had a higher likelihood of starting self- versus clinician-administered treatment (aRR, 1.16 95% CI, 1.08 to 1.25), but a lower probability of starting combination therapy versus self-administered treatment (aRR, 0.93 95% CI, 0.90 to 0.95). CONCLUSION Antimyeloma treatment initiation did not differ by type of Medicare coverage; however, MA beneficiaries were less likely than TM beneficiaries to initiate combination therapy—the standard of care. Future research is needed to examine the clinical outcomes associated with the type of antimyeloma treatment initiated by beneficiaries.