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. 2011 Dec 11;1(4):001.04.a04. doi: 10.5600/mmrr.001.04.a04

Exhibit 3. Percent of elderly hormone receptor-positive female breast cancer patients enrolled in a Medicare Part D prescription drug plan who were non-adherent to SERM or AI therapy, by patient characteristics, May 2006–December 2007.

Non-adherent to SERM Non-Adherent to AI
Non-low income subsidy Low income subsidy Non-low income subsidy Low income subsidy
Percent N p-value1 Percent N p-value1 Percent N p-value1 Percent N p-value1
All 21 2,084 24 560 30 5,151 20 1,651
Part D benefit-related
 Average out-of-pocket cost
for 30 day supply2
   No Part D low income
subsidy3
     $0-$4.99 17 666 10 317
     $5.00-$14.99 21 1,271 <0.001 12 479 <0.001
    $15.00-$29.99 355 135 33 2,245
     $30.00+ — 34 2,053
  Part D low income subsidy
    $0-$1.99 22 465 0.008 16 649
     $2.00-$4.99 356 95 21 710 <0.001
    $5.00+ — 26 292
Coverage gap benefits
   No 20 1,718 0.35 — 30 5,046 0.10 —
   Yes 23 366 — 23 105 —
 Plan type
 MAPD 21 970 0.87 33 116 0.01 26 2,369 <0.001 19 269 0.64
  PDP 21 1,114 22 444 33 2,782 20 1,382
Demographic/health status
  Age at Part D enrollment
   65-69 20 394 27 119 29 1,468 20 435
   70-79 19 1,046 0.09 24 259 0.62 30 2,561 0.49 19 801 0.83
   80+ 24 644 22 182 31 1,122 21 415
Race/ethnicity
 White non-Hispanic 21 1,823 22 355 30 4,401 18 960
 White Hispanic 28 97 0.001 25 77 0.46 32 272 0.04 21 266 0.05
Black (non-Hisp. & Hisp.) 37 51 31 75 37 214 26 252
 Other/unknown 12 113 26 53 25 264 19 173
Married
 No/unknown 21 975 0.55 24 438 0.70 33 2,335 <0.001 20 1,253 0.72
 Yes 20 1,109 25 122 28 2,816 21 398
Urban/rural
Large metro area 21 1,188 27 301 28 3,546 19 975
 Metro/urban 21 695 0.34 22 176 0.11 34 1,386 <0.001 23 533 0.12
 Less urban/rural 17 201 17 83 37 219 16 143
  Median income at census l
    tract/ ZIP Code level
    <$30K 19 216 30 166 34 395 23 468
    $30K-$49K 21 921 0.84 19 273 0.01 32 1,825 0.001 22 717 0.002
    $50K+/unknown 21 947 29 121 28 2,931 15 466
  HCC risk score
    <=1.00 18 1,125 29 181 29 2,707 18 455
    1.01-2.00 22 687 0.002 21 236 0.17 30 1,561 0.15 19 648 0.20
    2.01+ 28 272 24 143 33 883 22 548
Cancer-related
  Year of diagnosis
    2003 19 779 24 221 31 1,411 20 431
    2004 21 695 0.39 28 181 0.29 30 1,744 0.56 23 577 0.07
    2005 22 610 20 158 30 1,996 17 643
Stage at diagnosis
  I 21 1,412 22 293 30 2,768 17 712
  II 20 596 0.11 25 225 0.40 30 1,885 0.78 22 683 0.06
  III/IV 30 76 31 42 31 498 22 256
Initial surgery/radiation
 Mastectomy 20 672 23 257 30 1,756 20 800
 BCS+radiation 21 1,054 0.91 26 200 0.72 29 2,655 0.04 20 587 1.00
  BCS, no radiation4 21 358 22 103 34 740 20 264
1

p-value for difference between patient characteristic and non-adherence.

2

Prior to the coverage gap.

3

Excludes 12 SERM and 57 AI cases with no pre-coverage gap claims.

4

Includes unknown radiation therapy status.

5

Includes 22 cases with out-of-pocket costs of $30+.

6

Includes 11 cases with out-of-pocket costs of $5+.

Notes:

  • SERM = selective estrogen receptor modulator; AI = aromatase inhibitor; BCS=breast conserving surgery; MAPD=Medicare Advantage prescription drug plan; PDP=stand-alone prescription drug plan; HCC= Hierarchical Condition Category.
  • Table includes beneficiaries diagnosed between 2003 and 2005 with at least 12 months of Part D enrollment between May 2006 and December 2007. Cases with both AI and SERM were excluded from this analysis.
  • Non-adherence is defined as a medication possession ratio of less than 80 percent.

Source: SEER-Medicare.