An Insurer's Program To Incentivize Generic Oncology Drugs Did Not Alter Treatment Patterns Or Spending On Care

The high and rising costs of anticancer drugs have received national attention. The prices of brand-name anticancer drugs often dwarf those of established generic drugs with similar efficacy. In 2007-16 UnitedHealthcare sought to encourage the use of several common low-cost generic anticancer drugs by offering providers a voluntary incentivized fee schedule with substantially higher generic drug payments (and profit margins), thereby increasing financial equivalence for providers in the choice between generic and brand-name drugs and regimens. We evaluated how this voluntary payment intervention affected treatment patterns and health care spending among enrollees with breast, lung, or colorectal cancer. We found that the incentivized fee schedule had neither significant nor meaningful effects on the use of incentivized generic drugs or on spending. Practices that adopted the incentivized fee schedule already had higher rates of generic anticancer drug use before switching, which demonstrates selection bias in take-up. Our study provides cautionary evidence of the limitations of voluntary payment reform initiatives in meaningfully affecting health care practice and spending.