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The Impact of High Costs on Patients Filling Prescriptions for Oral Cancer Drugs

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Patients with cancer may have more options for oral cancer medications, but high out-of-pocket costs still present a barrier to access, according to a new study in Journal of Clinical Oncology.

Researchers reviewed claims from 2014 to 2015 from a large, proprietary, integrated database that included Medicare and commercial insurance enrollees for 38 oral anticancer agents. They looked at claim reversal (patients failing to purchase an approved prescription), delayed initiation, and abandonment.

The overall abandonment rate was 18% and rates of claim reversal ranged from 13% to 67% depending on the out-of-pocket (OOP) costs. The study found that 10% of patients who had to pay less than $10 did not pick up their prescription, while 32% of those who had to pay between $100 and $500 and nearly 50% of those who had to pay more than $2000 did not pick up their prescription.

“Patients in our study were facing a new cancer diagnosis or a change in their disease that required a new treatment. Imagine leaving your doctor’s office with a plan, ready to start treatment, only to find you can’t afford it,” lead author Jalpa A. Doshi, PhD, a professor in the Perelman School of Medicine at the University of Pennsylvania, and director of Value-Based Insurance Design Initiatives at the Leonard Davis Institute’s Center for Health Incentives and Behavioral Economics, said in a statement. “It adds more stress at what is already a stressful and scary time.”

The researchers also found that the relationship between high OOP costs and patients not filling their prescriptions was consistent across cancers, even for those that have treatments that significantly extend life. Patients with high OOP costs who did fill their prescriptions were more likely to delay it. With oral drugs, more of the medication’s cost is passed to the patient and complete payment is due upfront, which increases the risk of delayed access or abandonment.

The authors determined that if patients currently paying between $50 and $100 for prescription were bumped up to a higher cost category and were responsible for $100 to $500 instead, that the abandonment rates would actually double.

“This shows the importance of discussing financial barriers up front, during conversations about treatment options, even with patients who don’t raise concerns,” Doshi said. “Patients may not be aware of how expensive their prescriptions will be, and physicians may not realize that a patient has opted not to fill the prescription.”

This post originally appeared in the AJMC In Focus blog.

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