January 17, 2018
2 min read

High out-of-pocket oral cancer drug costs linked with delayed treatment initiation, abandonment

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High out-of-pocket costs for oral cancer drugs appeared linked with prescription abandonment and delayed treatment initiation, according to findings published in Journal of Clinical Oncology.

“Patients in our study were facing a new cancer diagnosis or a change in their disease that required a new treatment,” Jalpa A. Doshi, PhD, professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, said in a press release. “Imagine leaving your doctor’s office with a plan, ready to start treatment, only to find you can’t afford it. It adds more stress to what is already a stressful and scary time.”

The researchers performed a retrospective study of Medicare and commercial insurance enrollees using data from 2014 and 2015 (n = 38,111). Patients had received prescriptions for any of 38 different oral cancer drugs. Doshi and colleagues evaluated rates of claim reversal — instances in which patients failed to fill prescriptions — as well as delayed initiation, defined as reversal with subsequent filling of prescription within 90 days, and treatment abandonment. The researchers also assessed whether patients filled alternate prescriptions, such as infusible, injectable or alternate oral anticancer drugs, within 90 days. Doshi and colleagues used logistic regression to control for clinical and treatment characteristics as well as socioeconomic demographics.

Risk-adjusted rates of claim reversal ranged from 13% to 67%. These rates increased alongside out-of-pocket drug costs.

The overall rate of treatment abandonment was 18%; however, when drugs were divided into cost categories, these rates increased. The abandonment rate was 10% for costs of $10 or less, compared with 13.5% for $50.01 to $100, 31.7% for costs of $100.01 to $500; 41% for costs of $500.01 to $2,000 and 49.4% for costs of more than $2,000 (P < .001). These rates remained similar even after researchers accounted for use of alternate therapies.

Higher costs also correlated with delayed initiation. The delayed initiation rate was 3% for costs of $10 or less, compared with 18% for costs of more than $2,000 (P < .001). These associations remained similar in sensitivity and subgroup analyses by pharmacy type, sex, insurance type and indication.

“Our results highlight the pressing need for all stakeholders — including manufacturers, pharmacy benefit managers, payers and policymakers — to identify fiscally sustainable strategies to improve patient access to cancer medications,” Doshi and colleagues wrote. – by Andy Polhamus

Disclosures: Doshi reports consulting or advisory roles with Alkermes, Allergan, Ironwood Pharmaceuticals, Sage Therapeutics, Sanofie, Shire and Vertex Pharmaceuticals; and research funding from AbbVie, Biogen, Humana, Jensen, National Pharmaceutical Council, Novartis, Pfizer, PhRMA, Regeneron and Sanofi. Please see the full study for all other authors’ relevant financial disclosures.