High Costs and Coverage Gaps Remain Key Barriers to NCCN-Preferred CLL Therapies

In an interview with Pharmacy Times, Joanna Rhodes, MD, MSCE, director of the lymphoma program at RWJBarnabas Health in New Jersey, outlined the financial and insurance challenges pharmacists routinely encounter when helping patients access National Comprehensive Cancer Network-preferred novel therapies for chronic lymphocytic leukemia. Despite the availability of highly effective Bruton tyrosine kinase (BTK) and B-cell lymphoma 2 (BCL-2) inhibitors, their steep monthly costs—combined with variable formulary coverage and high deductibles common among Medicare, Medicaid, and high-deductible plans—create significant hurdles, especially for underserved populations.

Q: From a pharmacy practice standpoint, what barriers do pharmacists observe in accessing or initiating National Comprehensive Cancer Network-preferred novel therapies for chronic lymphocytic leukemia (CLL), particularly among underserved populations?

Joanna Rhodes, MD, MSCE: I think one of the big challenges has to do with insurance coverage and prescription coverage. So, when we look at our novel agents as a whole, on average, a month's supply of a covalent Bruton tyrosine kinase (BTK) inhibitor, whether first or second generation, or a B-cell lymphoma 2 (BCL-2) inhibitor, has a retail market value anywhere from $10,000 to $16,000 a month. Different insurance companies have different formularies; they have different coverages. But I think that this becomes very important when we think about our Medicare and Medicaid patients who may have very high deductibles or patients that have high deductible plans. And so, I think that that's when the cost of medications becomes a huge barrier.

I think for patients, in particular, when we think about what patient copays are, there are foundation assistance programs and prescription assistance programs that help to try and leverage those gaps. But I don't think that they're going to be enough long-term, particularly when we think about treatments that are true to progression, such as treating with covalent second generation, covalent BTK inhibitors, and even in the relapse setting, non-covalent BTK inhibitors as well.