Large Portion of Oral Cancer Drugs Abandoned at Pharmacy Due to Out-of-Pocket Costs

Despite the benefits of oral oncolytics, high out-of-pocket costs could put treatment out of reach for patients with cancer.

Oral oncoloytics have the potential to transform the cancer landscape. Instead of taking hours to travel to a hospital or an infusion center to receive cancer treatment, patients are able to take an oral drug wherever they may be.

These oral cancer treatments not only allow patients to keep their schedule similar to what it was before their diagnosis, but the drugs also may be able to reduce overall medical costs.

However, the challenge of high out-of-pocket (OOP) costs for oral cancer drugs may prevent patients from properly adhering to therapy, according to a study published by the Journal of Clinical Oncology. The authors discovered that high OOP costs may be a barrier to life-saving treatments.

As more oral cancer drugs emerge, the study questions whether there will be an uptick in this type of therapy or if the OOP costs may present a hurdle to adherence.

The authors analyzed a large prescription drug database that included more than 38,000 patients who received a prescription for 1 of 38 oral cancer drugs between 2014 and 2015.

The investigators found that only 10% of patients did not pick up their prescription when their co-payment was less than $10.

The abandonment rate jumped to 32% when patients had to pay between $100 and $500 for oral cancer drugs, according to the study.

Additionally, nearly half of patients who had to pay more than $2000 OOP for oral cancer treatments abandoned the prescription.

The link between high OOP costs and prescription abandonment was consistent across all types of cancers, according to the study. The authors noted that these findings remained true even after accounting for type of insurance, pharmacy, and patient characteristics.

Even when patients with high OOP costs filled their prescriptions, the authors noted there was a delay.

Numerous other studies show that insured patients with other conditions are likely to delay, interrupt, or discontinue therapy altogether if they have high OOP costs.

The authors of the current study said that their findings are particularly concerning due to the life-threatening nature of cancer.

“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,” said lead author Jalpa A. Doshi, PhD. “It adds more stress at what is already a stressful and scary time.”

Since oral cancer therapies are covered under the pharmacy benefit, more costs may be passed to the patient through coinsurance. Additionally, payment is due up front rather than after treatment. These factors were observed to increase the risk of abandonment and could delay the start of therapy, according to the study.

The authors also investigated whether patients started other cancer treatments, including intravenous therapy. They discovered that few patients initiated alternative therapy.

“This shows the importance of discussing financial barriers up front, during conversations about treatment options, even with patients who don’t raise concerns,” Dr 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.”

Although only 1 in 8 patients in the study had OOP costs that exceeded $2000, costs this high have become more common as commercial insurance moves towards high deductible plans and high coinsurance, according to the study.

In line with current trends, the authors investigated what would happen if patient’s OOP costs reached the next cost category. They found that if patients who currently pay $50 to $100 per prescription were charged $100 to $500 instead, the abandonment rate would double, according to the study.

The authors said these findings suggest that OOP costs for oral cancer treatments may prevent patients from starting therapy.

“Our results highlight the pressing need for all stakeholders — including manufactures, pharmacy benefit managers, payers, and policy makers – to identify fiscally sustainable strategies to improve patient access to cancer medications,” the authors wrote.