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Low use of guideline-recommended treatment among Medicare Advantage and traditional Medicare beneficiaries with advanced lung cancer

Year: 2026
Type: article
Abstract: Medicare Advantage (MA) plans have grown in popularity and currently cover over half of all beneficiaries [1]. Although MA plans offer supplemental benefits and out-of-pocket maximums [2], they also employ numerous strategies to control health care spending. Specifically, MA plans often restrict care to in-network providers and require utilization management (e.g., prior authorization, step therapy) for nearly all self- and clinician-administered anticancer therapies [1]. Evidence suggests that MA enrollment is associated with a low likelihood of starting any or high-cost systemic therapies among beneficiaries with advanced lung cancer [1,3], raising concerns that cost-containment strategies could limit access to guideline-recommended care.
DOI: 10.1016/j.jgo.2026.104685
Institutions: Wake Forest University Health Sciences, Wake Forest University, Veterans Health Administration, VA Tennessee Valley Healthcare System, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center
Language: English
Open Access status: hybrid
Estimated APC paid: $3,610
Funders: Bristol-Myers Squibb, California Department of Public Health, University of Southern California, Vanderbilt-Ingram Cancer Center, Centers for Disease Control and Prevention, University of California, San Francisco, National Cancer Institute
Awards: G1352184354, G1395202410, G2337224928, G2612351997, G275963511, G3448447748, G3509688676, G3632360174, G4332884407, G4428815567, G4854421162, G504639888, G5631299761, G5821893214, G6951404960, G7290139498, G7705257630, G8083727551, G8509442309, G9000055636, G946791773
OpenAlex ID: W7225338946
FWCI:
Cites: 11
Cited by:
Related to: 10