Medicare Advantage Less Likely to Use Low-Value Cancer Treatments, Study Finds

Medicare Advantage, an alternative to traditional Medicare that offers beneficiaries private health plan options, has grown substantially in the past ten years. In 2024, 54% of individuals with Medicare were enrolled in Medicare Advantage.

With incentives to reduce costs, Medicare Advantage plans typically use managed care approaches that are not utilized by traditional Medicare. These can include network restrictions, step therapy, and prior authorization requirements. These strategies may curtail the use of low-value services, including high-cost treatments that have low-cost alternatives and medically unnecessary health care.

Previous studies have compared the use of low-value services between traditional Medicare and Medicare Advantage in general populations. However, none have compared the two plans in their use of low-value services in cancer treatment. Some studies have found Medicare Advantage less likely to use low-value services in the general population compared to traditional Medicare. Others have found no difference.

To gain knowledge on the differences between Medicare Advantage and traditional Medicare in the use of low-value cancer treatments, Jeah Jung, Ph.D., M.P.H., from the Department of Health Administration and Policy at George Mason University, and his colleagues conducted a retrospective analysis of Medicare beneficiaries who had a new cancer diagnosis between 2016 and 2021.

The results were published in late May 2025 in the Journal of Clinical Oncology.

The researchers used data from national Medicare Advantage encounters and traditional Medicare claims to identify 80,881 Medicare Advantage enrollees and 142,583 traditional Medicare beneficiaries. The study analyzed six low-value cancer treatments, including two non-recommended treatments and four high-cost treatments for which low-cost alternatives exist.

Non-recommended treatments included the use of granulocyte-colony stimulating factors (GCSFs) for patients on low-risk chemotherapy and Prolia (denosumab) for castration-sensitive prostate cancer (CSPC). The use of GCSFs in patients receiving chemotherapy with a lower than 10% risk of neutropenic fever is not recommended by the National Comprehensive Cancer Network or the American Society of Clinical Oncology (ASCO). Bone-modifying agents, such as denosumab, are not recommended for use in patients with CSPC due to a lack of benefit seen in clinical trials.

The four high-cost options evaluated are as follows: 1) using Abraxane (nab-paclitaxel) instead of paclitaxel in patients with lung or breast cancer, 2) adding Avastin (bevacizumab) to carboplatin plus paclitaxel in ovarian cancer treatment, 3) using brand-name drugs instead of generic options, and 4) using brand-name biologics instead of available biosimilars.

The study results showed that the adjusted rate for using any low-value cancer treatment was 1.7 percentage points lower in Medicare Advantage beneficiaries compared with traditional Medicare enrollees (34.2% versus 3.9%). When analyzing specific treatment use, the researchers found that denosumab use in patients with CSPC was 6.6 percentage points lower with Medicare Advantage than with traditional Medicare. The use of Avastin with carboplatin and paclitaxel was 2.3 percentage points lower in Medicare Advantage than in traditional Medicare.

The rate of biologics versus biosimilar use was 1.7 percentage points lower in the Medicare Advantage group compared to traditional Medicare. GCSF use was 1.6 percentage points lower for Medicare Advantage versus traditional Medicare. Abraxane versus paclitaxel use was 0.8 percentage points lower in the Medicare Advantage group. The results showed no difference in branded versus generic drug use between Medicare Advantage and traditional Medicare, with both groups showing a 15% use of branded drugs instead of generics.

Based on these results, Jung and his team concluded that Medicare Advantage plans have a lower rate of low-value cancer treatment use compared with traditional Medicare. However, they advocate efforts to find ways to reduce low-value cancer treatments in both traditional Medicare and Medicare Advantage plans.

The authors wrote, “…34.2% of [Medicare Advantage] enrollees and 35.9% of [traditional Medicare] beneficiaries received at least 1 low-value cancer treatment. This suggests that opportunities remain to reduce use of wasteful cancer treatments in both [Medicare Advantage and [traditional Medicare].”

“Increased efforts are needed to identify approaches that [Medicare Advantage] plans use to reduce low-value cancer treatments and to promote those approaches,” they added.