BACKGROUND In this study we sought to estimate the association between oral oncology parity law adoption and anticancer medication use for patients with chronic myeloid leukemia (CML) or multiple myeloma. METHODS This was an observational study of administrative claims from 2008-2017. Among individuals initiating tyrosine kinase inhibitors (TKI) for CML or immunomodulatory drugs for multiple myeloma, we compared out-of-pocket spending, adherence, and discontinuation before and after parity among individuals in fully-insured plans (subject to parity) versus self-funded plans (exempt from parity) using propensity-score weighted difference-in-differences regression models. RESULTS Among patients initiating TKIs (N = 2,082) or immunomodulatory drugs (N = 3,326) there were no statistically significant differences in adherence or discontinuation associated with parity. The proportion of patients with initial out-of-pocket payments of $0 increased in fully-insured plans after parity from 5.7% to 46.1% for TKIs and from 10.9% to 48.8% for immunomodulatory drugs. Relative to changes in self-funded plans, those in fully-insured plans were 4.27 (95%CI:2.20-8.27) times as likely to pay nothing for TKIs and 1.96 (95%CI:1.40-2.73) times as likely to pay nothing for immunomodulatory drugs after parity. Similarly, the proportion paying >$100 decreased from 30.3% to 24.7% for TKIs and 30.6% to 27.5% for immunomodulatory drugs in fully-insured plans after parity. Relative to changes in self-funded plans, those in fully-insured plans were 0.74 (95%CI:0.54-1.01) times as likely to pay >$100 for TKIs and 0.85 (95%CI:0.68-1.06) times as likely to pay >$100 for immunomodulatory drugs after parity. CONCLUSIONS Among patients initiating TKIs or immunomodulatory drugs, parity was not associated with better adherence or less discontinuation of therapy, but yielded decreased patient out-of-pocket payments for some patients.

中文翻译：

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口腔癌的平价法律，药物的使用以及血液癌患者的自付费用。

背景技术在本研究中，我们试图评估慢性粒细胞白血病（CML）或多发性骨髓瘤患者的口服肿瘤平价法采纳与抗癌药物使用之间的关联。方法这是一项对2008年至2017年行政索赔的观察性研究。在针对CML发起酪氨酸激酶抑制剂（TKI）或针对多发性骨髓瘤的免疫调节药物的个体中，我们比较了完全保险计划中的个人在同等费用前后的自付费用，依从性和停药后（取决于同等费用）与使用倾向得分加权的差异差异回归模型来资助计划（免除平价）。结果在开始TKIs（N = 2,082）或免疫调节药物（N = 3，326）与平价相关的依从性或终止性在统计学上没有显着差异。在完全保险后的计划中，TKI的初始自付费用为0美元的患者比例从5.7％增加到46.1％，而免疫调节药物从同等比例从10.9％增加到48.8％。相对于自筹资金计划的变更，全额购买保险的人为TKI支付任何费用的可能性是未支付的4.27（95％CI：2.20-8.27）倍，有支付可能性的是1.96（95％CI：1.40-2.73）奇偶校验后免疫调节药物无效。同样，在完全保险后的同等保险计划中，TKI的支付比例大于100美元的比例从30.3％降至24.7％，免疫调节药物的比例从30.6％降至27.5％。相对于自筹资金计划的变化，全额购买保险计划的人支付TKI大于$ 100的可能性为0.74（95％CI：0.54-1.01）倍，为0。奇偶校验后为免疫调节药物支付> 100美元的可能性的85倍（95％CI：0.68-1.06）。结论在开始使用TKI或免疫调节药物的患者中，均价与更好的依从性或较少的治疗中断无关，但某些患者的自付费用减少。