Financial barriers in the form of payer-determined high cost sharing appear to play a role in targeted therapy treatment decisions under Medicare Part D in patients with metastatic renal cell carcinoma (RCC), according to a study involving >1,700 individuals. Participants—all with metastatic RCC—were Medicare beneficiaries from 2011- 2013 who either did or did not receive low income subsidies. Investigators looked at treatment initiation rates and time to initiation of various targeted therapies, including pazopanib. Among the results:

• Patients who did not receive subsidies had to pay ≥$2,800 out-of-pocket for initial therapy, vs <$7 for those who received subsidies.
• 21% of patients without subsidies initiated oral therapy, vs 34% of those with subsidies.
• 27% of patients without subsidies initiated any targeted therapy, vs 40% of those with subsidies.
• It took longer for patients without subsidies to access therapy.