Decision Resources, Inc., one of the world's leading research and advisory firms for pharmaceutical and health care issues, finds that office-based oncologists are pessimistic about the effect that the Medicare Modernization Act (MMA) will have on the chemotherapy-induced anemia drug market. One half of office-based oncologists say cuts in their own reimbursement rates and patients' inability to afford copayments and coinsurance will reduce cancer patients' access to erythropoiesis stimulating proteins (ESPs) such as Johnson & Johnson's Procrit and Amgen's Aranesp.
The new PhysicianForum report entitled Erythropoiesis Stimulating Proteins: Evolving Usage by Oncologists finds that more than one half of surveyed HMOs also say that Medicare claimants' out-of-pocket costs will increase in the wake of MMA reforms.
"Half of HMOs also expect increased out-of-pocket costs for private patients," says Mary Fletcher-Louis, analyst at Decision Resources. "HMOs say at least one third of patients will fall within the Part D coverage 'donut hole.' This term refers to the gap in Medicare Part D coverage when no insurance for prescription drugs is available. After total drug costs reach $2,250, patients pay an additional $2,850 out-of-pocket before Medicare Part D continues coverage. Based on Decision Resources' estimates of the average cost of a typical course of ESP treatment (four-five months), we believe that the actual percentage of patients falling within the 'donut hole' is likely to be higher than HMO estimates."
Erythropoiesis Stimulating Proteins: Evolving Usage by Oncologists is based on a U.S. survey of 20 HMO pharmacy directors, 51 hospital-based oncologists, and 53 office-based oncologists. Their responses were compared to assess similarities and differences of opinion regarding clinical, economic, and scientific factors.
PhysicianForum is a primary research service from Decision Resources that offers access to high volume-prescribing physicians, specialists, and managed care organization representatives in the United States; analysis of events and survey participants' responses to them; insight into prescribing patterns; and an examination of the implications of events and issues for the pharmaceutical market.
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SOURCE: Decision Resources, Inc.
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