Pharmaceutical assistance programs for cancer patients in the era of orally administered chemotherapeutics

Mitchell, Aaron P.; Muluneh, Benyam; Patel, Rachana; Basch, Ethan

doi:10.1177/1078155217719585

Cited by 17 publications

(18 citation statements)

References 20 publications

(27 reference statements)

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“…Similar studies have found that these types of financial assistance programs can play a role in reducing out-of-pocket expenses for prescriptions drugs and OAMs. [9][10][11][12] Mitchell et al (2018) performed a similar study that evaluated the number of oncology patients receiving patient assistance programs for OAMs and the retail value of the assistance. 13 This study found that 10.6% of patients obtained a patient assistance program for an oral cancer medication, where our quality improvement project showed 18.6% of patients received a patient assistance program.…”

Section: ■■ Discussionmentioning

confidence: 99%

Targeting Financial Toxicity in Oncology Specialty Pharmacy at a Large Tertiary Academic Medical Center

Farano

Kandah

2019

JMCP

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BACKGROUND: Patients with cancer often face financial toxicity. They may face financial distress because of high out-of-pocket costs that in turn can result in delays in treatment, treatment abandonment, and higher overall costs of care, all of which can have have a negative effect on patient care. A specialty pharmacy practice model can play a role in decreasing financial toxicity.OBJECTIVE: To evaluate the patient out-of-pocket costs after enrollment in manufacturer patient assistance programs, copay cards, and foundation grants by an oncology specialty pharmacy at University of Chicago Medicine (UCM). METHODS: For this quality improvement project, a retrospective analysis of prescription claims from January 2017 to June 2017 was performed. The primary outcomes included the number of patients enrolled in manufacturer patient assistance programs, copay cards, and foundation grants, along with the total dollars applied to pharmacy claims. The secondary outcome was the average days to approval of a foundation grant. Inclusion criteria for this quality improvement project included prescriptions filled at UCM Specialty Pharmacy in the 6-month time frame for an oncology indication. Exclusion criteria were prescriptions that were not filled at UCM Specialty Pharmacy due to out-of-network insurance and prescriptions that were part of a patient assistance program where the medication was directly shipped from the manufacturer.RESULTS: In the 6-month time frame, 75 patients received financial assistance, with a total cost savings of $314,857. Financial assistance was most frequently applied to the following medications: peg-filgrastim, dasatinib, abiraterone, filgrastim and filgrastim-sndz, palbociclib, venetoclax, and ruxolitinib. The cost savings of these interventions ranged between $5 and $13,138 per prescription claim. The average days from date of insurance approval to date of financial grant approval was 1.2 days. CONCLUSIONS: This project demonstrates the importance of an oncology specialty pharmacy team in ensuring timely approval of a foundation grant and reducing financial toxicity, which can play a major role in access to therapy.

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Section: ■■ Discussionmentioning

confidence: 99%

Targeting Financial Toxicity in Oncology Specialty Pharmacy at a Large Tertiary Academic Medical Center

Farano

Kandah

2019

JMCP

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“…10,17 In an earlier study by Zullig et al, 12 who investigated the use of PAPs for all anticancer medications dispensed by an academic oncology pharmacy, the median drug price was $2,762, and 12% of prescriptions were paid for with financial assistance. Similarly, Mitchell et al 11 reported on the use of PAP assistance among 10.6% of patients receiving any oral anticancer agents in a similar setting. In that study, 40% of recipients of charitable support were uninsured, and only 20% had Medicare coverage.…”

Section: Discussionmentioning

confidence: 90%

“…Previous studies indicated that approximately 10% to 15% of patients who received any cancer therapy used PAPs to offset out-of-pocket costs, but the extent of this support for the novel ultraexpensive anticancer agents has not been investigated. [10][11][12] Studies that directly assessed the use of PAPs concluded that they cover only a small percentage of total cancer drug costs, but they can facilitate access for underinsured individuals. [12][13][14] Our objective was to examine sources of payment for patients who have been prescribed novel oral anticancer agents by using data from an oncology specialty pharmacy that is linked to patients' clinical medical records and is affiliated with an academic cancer center.…”

Section: Introductionmentioning

confidence: 99%

Use of Charity Financial Assistance for Novel Oral Anticancer Agents

Olszewski

Zullo

Nering

et al. 2018

JOP

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Novel oral targeted drugs are increasingly used for cancer therapy, but their extreme cost, often exceeding $10,000 per month, poses a significant barrier for patients and insurers alike, leading to the potential breakdown of traditional cost-sharing strategies. Insured patients' routine use of charity assistance to supplement their coverage would indicate a major deficiency in the current health care policies. By using data from a specialty pharmacy affiliated with an academic center (1,557 prescriptions dispensed between January 2014 and March 2017), we examined sources of payment for novel oral anticancer agents, distinguishing contributions from health insurance, patients, and from charitable assistance organizations. Thirty-six percent of 211 patients received charity assistance, including 47% of patients who were 65 years old or older. Charity sources covered 4% of total drug costs and 64% of out-of-pocket expenditures. The proportion of patients receiving financial assistance ranged from 7% when the upfront out-of-pocket requirement was less than $100 to 67% when it exceeded $1,000. When patients' out-of-pocket requirement exceeded $1,000, the median direct cash contribution paradoxically fell to $0 because of extensive use of charity support. Receipt of upfront charity assistance was associated with a longer time to filling the first prescription (median 9 v 7 days; P = .011) and with longer overall duration of therapy (median, 261 v 134 days; P = .014). These findings indicate that high out-of-pocket burden for expensive novel oral anticancer drugs leads to widespread use of charity support in the United States and that a significant financial barrier disparately affects older Medicare beneficiaries.

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“…Uninsured or self-pay individuals are generally responsible for the full cost of their care unless they are able to navigate the complex structure of safety net resources, including hospital charity care, entitlement programs, manufacturer assistance, and nonprofit organization aid. 17,18 Yet the literature is clear; no group, regardless of insurance type or generosity, is fully immune from individual-level financial burden of cancer. 2,12,19 It is also worth noting that cancer treatment may not follow standard economic models of choice.…”

Section: What Is Financial Toxicity?mentioning

confidence: 99%

Financial Toxicity in Advanced and Metastatic Cancer: Overburdened and Underprepared

Rotter

Spencer

Wheeler

2019

JOP

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Patients with metastatic or advanced cancer are likely to be particularly susceptible to financial hardship for reasons related both to the characteristics of metastatic disease and to the characteristics of the population living with metastatic disease. First, metastatic cancer is a resource-intensive condition with expensive treatment and consistent, high-intensity monitoring. Second, patients diagnosed with metastatic disease are disproportionately uninsured and low income and from racial or ethnic minority groups. These vulnerable subpopulations have higher cancer related financial burden even in earlier stages of illness, potentially resulting from fewer asset reserves, nonexisting or less generous health insurance benefits, and employment in jobs with less flexibility and fewer employment protections. This combination of high financial need and high financial vulnerability makes those with advanced cancer an important population for additional study. In this article, we summarize why financial toxicity is burdensome for patients with advanced disease; review prior work in the metastatic or advanced settings specifically; and close with implications and recommendations for research, practice, and policy.

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Pharmaceutical assistance programs for cancer patients in the era of orally administered chemotherapeutics

Cited by 17 publications

References 20 publications

Targeting Financial Toxicity in Oncology Specialty Pharmacy at a Large Tertiary Academic Medical Center

Targeting Financial Toxicity in Oncology Specialty Pharmacy at a Large Tertiary Academic Medical Center

Use of Charity Financial Assistance for Novel Oral Anticancer Agents

Financial Toxicity in Advanced and Metastatic Cancer: Overburdened and Underprepared

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