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State insurance mandates and off‐label use of chemotherapy

Author

Listed:
  • Fabrice Smieliauskas
  • Hari Sharma
  • Connor Hurley
  • Jonas A. de Souza
  • Ya‐Chen Tina Shih

Abstract

Access to cancer drugs used off‐label is important to cancer patients but may drive up healthcare costs with little evidence of clinical benefit. We hypothesized that state health insurance mandates for private insurers to provide coverage for off‐label use of cancer drugs cause higher rates of off‐label use. We used Truven MarketScan data from 1999 to 2007 on utilization of 35 infused chemotherapy drugs in private health plans in the United States, covering the period when eight states implemented off‐label coverage laws. We studied trends in off‐label use of drugs, distinguishing between appropriate and inappropriate off‐label use according to drug compendia, and estimated difference‐in‐difference regressions of the effect of state laws on off‐label use. We estimate 41% of utilization was off‐label, including 17% of use conservatively defined as inappropriate. Trends show gradual declines in off‐label use over time. We also find no discernable effect of state laws mandating coverage of off‐label use of cancer drugs on utilization patterns under multiple empirical specifications. Our conclusion is that policymakers should consider shifting away from mandating coverage as a way to ensure access to drugs off‐label and towards incentivizing adherence to clinical practice guidelines to improve the quality and value of off‐label use.

Suggested Citation

  • Fabrice Smieliauskas & Hari Sharma & Connor Hurley & Jonas A. de Souza & Ya‐Chen Tina Shih, 2018. "State insurance mandates and off‐label use of chemotherapy," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 55-70, January.
    • Handle: RePEc:wly:hlthec:v:27:y:2018:i:1:p:e55-e70
    DOI: 10.1002/hec.3537
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    References listed on IDEAS

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    1. Natalie Chun & Minjung Park, 2013. "The impact of health insurance mandates on drug innovation: evidence from the United States," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 323-344, April.
    2. Marianne P. Bitler & Christopher S. Carpenter, 2016. "Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses," American Economic Journal: Economic Policy, American Economic Association, vol. 8(3), pages 39-68, August.
    3. A. Colin Cameron & Douglas L. Miller, 2015. "A Practitioner’s Guide to Cluster-Robust Inference," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 317-372.
    4. Schmidt, Lucie, 2007. "Effects of infertility insurance mandates on fertility," Journal of Health Economics, Elsevier, vol. 26(3), pages 431-446, May.
    5. Marianne Bitler & Lucie Schmidt, 2012. "Utilization of Infertility Treatments: The Effects of Insurance Mandates," Demography, Springer;Population Association of America (PAA), vol. 49(1), pages 125-149, February.
    6. Mary K. Hamman & Kandice A. Kapinos, 2016. "Colorectal Cancer Screening and State Health Insurance Mandates," Health Economics, John Wiley & Sons, Ltd., vol. 25(2), pages 178-191, February.
    7. Timothy G. Conley & Christopher R. Taber, 2011. "Inference with "Difference in Differences" with a Small Number of Policy Changes," The Review of Economics and Statistics, MIT Press, vol. 93(1), pages 113-125, February.
    8. Joshua D. Angrist & Jörn-Steffen Pischke, 2014. "Mastering ’Metrics: The Path from Cause to Effect," Economics Books, Princeton University Press, edition 1, number 10363.
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