Facilitating Access to Oncology Medication
Timely access to cancer treatment improves patient outcomes.
A growing body of research supports the importance of timely access to cancer treatment because patients who obtain prompt care have been found to have better outcomes, including improved quality of life and increased survivability.1 Though the impact of timely access to care is well documented, time to treatment initiation (TTI) for patients with newly diagnosed cancer in the United States is increasing.
A recent study found TTI for all cancers increased by 38% during a 9-year observation period.2 In order to understand the factors leading to this increase, it is important to assess the social determinants of health (SDOH) influencing access to oncology medications, how they affect TTI, and the role of oncology-focused specialty pharmacies in facilitating timely access to prescribed therapy.
SDOH Influencing Medication Access
The fastest-growing population group in the United States is those aged 85 years and over, with the 85-plus age group projected to reach 19 million individuals by 2060. An aging population will increase demand for cancer-related services.3
As demand increases, shortages of medical oncologists will challenge our health system. Projections indicate a 40% growth rate in oncologists will be required to meet this growing demand, yet the current growth rate is only 5%.4
In 2020, the FDA approved a record 19 new cancer drugs.5 Looking ahead, 65% of new drug approvals over the next several years will target cancer or rare disease.4 A recent report analyzed the challenges faced by developed countries regarding access to oncology medicines and found uncertainty around clinical benefits, products with multiple indications, and pricing challenges for therapies used in combination with other treatments were impeding sustainable access to oncology medications.6 The cost of cancer treatment is increasing. The US spent $200.7 billion on cancer in 2020, and that cost is projected to reach $245.6 billion by 2030.7 As costs rise, patient cost-sharing has increased. In a recent analysis of US specialty pharmacy trends, payers listed “increased cost-sharing” as a leading strategy across both commercial and Medicare patients.8 Recent research shows the average out-of-pocket costs for cancer treatment has increased by more than 15%.9
Impact on TTI
Record growth in the number of specialty drugs treating cancer has created unique challenges for the public and private health plans who pay for treatment. Payers incorporate utilization management (UM) strategies to determine whether prescribed therapy is medically necessary and appropriate.10 Common UM strategies used by payers include prior authorization requirements, drug formularies, step therapy, and specialty drug tiers.
However, UM can ultimately limit the access patients have to novel therapeutics even years after their FDA approval.11 A recent survey found 1 in 3 patients experienced a delay in their care due to UM.12 According to the American Medical Association, 94% of physicians report the prior authorization (PA) process leads to delays in necessary care.13 Although the need for UM is generally understood, a growing coalition of health care organizations are advocating to reform UM strategies.14
Oncologists are faced with increased demand for quality care, arduous administrative tasks, and an ongoing shortage of health care workers, yet physicians and their staff spend an average of 2 full business days each week completing PA requirements.14
Amanda Hasenei is a referral specialist for BioMatrix Specialty Pharmacy, and her primary responsibilities include assisting providers and patients with initiating and maintaining access to therapy.
“Prescribers are forced to navigate an increasingly complex landscape of burdensome administrative requirements while juggling dose changes, refills, and keeping up with which pharmacies have access to limited distribution oncology medications,” Hasenei said.
PA requirements are not the only cause of delay at the practice level. A recent study analyzed chemotherapy treatment delays in ambulatory oncology practices. Delays occurred across stages of the care process and originated within organizational structure, communication/coordination, and communication technologies.15
A significant challenge impeding medication access for oncology patients is financial toxicity. The cost of oncology medication often significantly exceeds household income for most patients.16 Patients with higher out-of-pocket costs are more likely to be non-adherent or to discontinue treatment.17
Additionally, issues such as financial toxicity are compounded by health disparities. Cancer health disparities are widely documented and include obstacles in obtaining timely access to care.18 The experience of these disparities by patients can lead to additional burdens and different treatment outcomes and can be found to correlate to race, disability, gender identity, geographic location, income, education, age, sexual orientation, and national origin.
Role of Specialty Pharmacy
Specialty pharmacies play an important role in facilitating timely access to prescribed therapy. Coordinating support across health care stakeholders, specialty pharmacies can reduce barriers to care throughout the treatment process.
“Specialty pharmacies following a center of excellence model focus their competencies and clinical acumen to address critical issues such as therapy initiation times,” said Joshua Stoneking, PharmD, vice president, oncology, BioMatrix Specialty Pharmacy. “Coordinated efforts by a multidisciplinary, oncology-experienced team means patients experience a high level of support at every step of their journey.”
Additionally, specialty pharmacies can help oncologists stretch resources and provide support that can lead to improved outcomes and timely access to prescribed medications.
“Communication with patients and prescribers is key,” said Kionna Oleru, PharmD, a pharmacy manager at BioMatrix Specialty Pharmacy and Next-Generation Pharmacist® award winner. “The most pressing challenge is often high medication cost and insurance restrictions. We complete a thorough benefit investigation and assist with PA or other payer-mandated requirements while identifying resources for financial support.”
Oleru also noted the importance of providing comprehensive medication therapy management (MTM), including detailed medication reconciliation and a start of care assessment in identifying clinically relevant information. MTM conducted by an oncology-experienced pharmacist provides clinical support that has been shown to improve outcomes, reduce cost, and prevent drug complications.19
As new therapies are approved, specialty pharmacies capture important real-world data (RWD), demonstrating the impact of prescribed therapy. Working with patients, drug manufacturers, prescribers, and clinical research organizations, specialty pharmacies can help provide this data to advance evidence-based treatment protocols. This RWD provides valuable insight as the health care system pivots to a more sustainable, value-based model of care.
Patient navigation services improve timely access to cancer care.20 Specialty pharmacies employing patient-centric support reduce barriers at the individual patient level—including for populations at a greater risk of experiencing cancer disparities.
“Specialty pharmacies providing culturally competent care recognize and appropriately address issues that may impede patients from accessing and maintaining prescribed therapy,” said Royce Burruss, MBA, RPh, FASCP, corporate director, clinical services, BioMatrix Specialty Pharmacy. “Understanding constraints that can prohibit patients from accessing care allows us to deploy appropriate resources that bridge coverage gaps, provide financial assistance, and coordinate referrals to appropriate local service programs.”
Timely access to prescribed therapy is an essential component of quality cancer treatment. Increasing TTI can threaten quality of life and survivability for patients with newly diagnosed cancer.
Access to quality care is influenced by SDOH, which can ultimately impact TTI. Specialty pharmacies providing service-oriented, patient-centric support can reduce barriers to care, increase clinical support, and provide data that can facilitate the transition to a value-based model of care.
- World Health Organization. (2017). Guide to cancer early diagnosis. World Health Organization. https://apps.who.int/iris/handle/10665/254500. License: CC BY-NC-SA 3.0 IGO
- Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, et al. (2019). Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLOS ONE 14(4): e0215108. https://doi.org/10.1371/journal.pone.0215108
- Simon, S. (2019). Rapidly growing older population increases demand for cancer care in the US. American Cancer Society. https://www.cancer.org/latest-news/rapidly-growing-older-population-increases-demand-for-cancer-care-in-us.html
- Buruss R., Lindhorst, J. (2020). What does excellence in oncology pharmacy look like. Pharmacy Times. https://www.pharmacytimes.com/view/what-does-excellence-in-oncology-pharmacy-look-like
- Jerimias, S. (2021). Cancer treatments, orphan drugs, gene therapies represent big areas to watch in specialty drug pipeline. The American Journal of Managed Care. https://www.ajmc.com/view/cancer-treatments-orphan-drugs-gene-therapies-represent-big-areas-to-watch-in-specialty-drug-pipeline
- OECD. (2020). Addressing challenges in access to oncology medications. https://www.oecd.org/health/health-systems/addressing-challenges-in-access-to-oncology-medicines.htm
- Cancer access network. (2020). The costs of cancer. The American Cancer Society. https://www.fightcancer.org/sites/default/files/National%20Documents/Costs-of-Cancer-2020-10222020.pdf
- Bangia, I., Neumann, U. (2021). Key trends in US specialty pharmacy. Certara. https://www.certara.com/app/uploads/2021/01/Key-Trends-in-U.S.pdf
- Ya-Chen T. Shih. (2021). Oral abstract session B. American Society of Clinical Oncology. https://meetinglibrary.asco.org/record/201675/abstract
- Institute of Medicine. (1989). Controlling Costs and Changing Patient Care?: The Role of Utilization Management. The National Academies Press. https://doi.org/10.17226/1359
- Shaw DL, Dhruva SS, Ross JS. Coverage of novel therapeutic agents by Medicare prescription drug plans following FDA approval. J Manag Care Spec Pharm. 2018;24(12):1230-1238. doi: 10.18553/jmcp.2018.24.12.1230
- Kent, J. (2019). Utilization management delays cancer care, diminishes outcomes. Health Payer Intelligence. https://healthpayerintelligence.com/news/utilization-management-delays-cancer-care-diminishes-outcomes
- American Medical Association. (2021). 2020 AMA prior authorization physician survey. https://www.ama-assn.org/system/files/2021-04/prior-authorization-survey.pdf
- American Medical Association. (2017). Health care coalition calls for prior authorization reform. https://www.ama-assn.org/press-center/press-releases/health-care-coalition-calls-prior-authorization-reform
- Lafferty, M., Fauer, A., Wright, N., Manoilovich, M., Friese, CR. (2020). Causes and consequences of chemotherapy delays in ambulatory oncology practices: A multisite qualitative study. Oncology Nursing Forum. 47(4), 417-427. DOI: 10.1188/20.ONF.417-427
- Natasha B. Leighl, MD1; Sharon Nirmalakumar, BSc1; Doreen A. Ezeife, MD2; and Bishal Gyawali, MD, PhD3. (2021). An arm and a leg: the rising cost of cancer drugs and impact on access. American Society of Clinical Oncology Educational Book. 41 (May 6, 2021) e1-e12. DOI: 10.1200/EDBK_100028
- Stacie B. Dusetzina , Aaron N. Winn, Gregory A. Abel , Haiden A. Huskamp , Nancy L. Keating. (2013). Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia.Journal of Clinical Oncology. 32, no. 4 (February 01, 2014) 306-311. DOI: 10.1200/JCO.2013.52.9123
- National Cancer Institute. (2020). Cancer disparities. https://www.cancer.gov/about-cancer/understanding/disparities
- Alexander M, Gabre E, Gatwood K, Gatwood J. Impact of clinical pharmacists in outpatient oncology practices: a review. Am J Health Syst Pharm. 2017;74(19):1549-1557. doi:10.2146/ajhp160475
- Freund, K. M., Battaglia, T. A., Calhoun, E., Darnell, J. S., Dudley, D. J., Fiscella, K., Hare, M. L., LaVerda, N., Lee, J. H., Levine, P., Murray, D. M., Patierno, S. R., Raich, P. C., Roetzheim, R. G., Simon, M., Snyder, F. R., Warren-Mears, V., Whitley, E. M., Winters, P., Young, G. S., … Writing Group of the Patient Navigation Research Program. (2014). Impact of patient navigation on timely cancer care: the patient navigation research program. Journal of the National Cancer Institute, 106(6), dju115. https://doi.org/10.1093/jnci/dju115