Presentation (CTI)

OBJECTIVES: Evidence comparing health care utilization between managed care and fee-for-service Medicare populations remains limited due to challenges in obtaining comparable utilization data. This gap is particularly important for cancer patients requiring complex care. This study compared characteristics between Medicare Advantage Prescription Drug plans (MA-PD) and standalone Prescription Drug Plans (PDP), and evaluated their associations with health care utilization among Medicare beneficiaries with cancer.
METHODS: A pooled retrospective observational study was conducted using data from the 2020-2022 Medicare Current Beneficiary Survey (MCBS), linked with Medicare administrative claims. Medicare beneficiaries with a cancer diagnosis were identified and classified as MA-PD or PDP enrollees. Health care utilization outcomes included inpatient events, outpatient events, and prescription drug events. Multivariable linear regression models were applied to log-transformed outcomes to estimate adjusted differences between plan types, adjusting for demographics, socioeconomic characteristics, and functional status.
RESULTS: The study included 7.85 million weighted MA-PD beneficiaries (55.92%) and 6.18 million weighted PDP beneficiaries (44.08%). Compared with PDP enrollees, MA-PD beneficiaries were more likely to be racial minorities, reside in metropolitan areas, have lower income and educational attainment, and report greater functional limitations. MA-PD beneficiaries had lower inpatient and outpatient utilization (p < 0.05). After adjustment, MA-PD enrollment was associated with 3.55% fewer inpatient, 41.87% fewer outpatient events, and 7.44% fewer prescription drug events compared with PDP enrollment (all p < 0.05).
CONCLUSIONS: Among Medicare beneficiaries with cancer, MA-PD and PDP enrollees differed in sociodemographic characteristics and health care utilization. MA-PD enrollment was consistently associated with lower inpatient, outpatient, and prescription drug use. As Medicare Advantage enrollment continues to expand, policymakers should consider how Part D plan type may differentially affect service use among cancer patients and assess whether lower utilization reflects improved care coordination or potential barriers to needed outpatient care.