Systems-Level Changes to Address Financial Toxicity in Cancer Care

Giap, Fantine; Chino, Fumiko; Gupta, Arjun

doi:10.1200/op.22.00085

Cited by 5 publications

(5 citation statements)

References 11 publications

(14 reference statements)

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“…At a time when mitigation of financial toxicity is receiving much attention, this work highlights the complexity of designing and implementing meaningful pharmaceutical interventions, even when efforts to decrease out-of-pocket costs are well intentioned. Oncology clinicians have limited time, training, and resources to address out-of-pocket medication costs for patients, especially at the point of prescribing, since these costs can be opaque and unpredictable [ 21 ]. There is a critical need for systems-level changes to allow oncology clinicians to help patients access affordable medications.…”

Section: Discussionmentioning

confidence: 99%

“…There is a critical need for systems-level changes to allow oncology clinicians to help patients access affordable medications. For example, electronic medical record tools can provide clinicians with the price of medications and their suitable alternatives at different pharmacies at the time of ordering (e.g., real-time benefit tools) [ 21 , 22 ]. We have previously demonstrated how prices of supportive care medications can vary dramatically by the dose/formulation; for example, the cost of a 37.5 mcg/h transdermal fentanyl patch is much higher than the combined cost of 25 and 12 mcg/h patches, and is even higher than a 50 mcg/h patch [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Implementing real-time benefit tools across pharmacies would require the cooperation of multiple stakeholders: electronic medical record vendors, payers, pharmacies etc. [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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The least costly pharmacy for cancer supportive care medications over time: the logistic toxicity of playing catch up

Etteldorf

Sedhom

Rotolo

et al. 2022

Support Care Cancer

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Purpose No single pharmacy in an urban zip code is consistently the least expensive across medications. If medication prices change differently across pharmacies, patients and clinicians will face challenges accessing affordable medications when refilling medications. This is especially pertinent to people with cancer with multiple fills of supportive care medications over time. We evaluated if the lowest-priced pharmacy for a formulation remains the lowest-priced over time. Methods We compiled generic medications used to manage nausea/vomiting (14 formulations) and anorexia/cachexia (12 formulations). We extracted discounted prices in October 2021 and again in March 2022 for a typical fill at 8 pharmacies in Minneapolis, Minnesota, USA (zip code 55,414) using GoodRx.com. We examined how prices changed across formulations and pharmacies over time. Results Data were available for all 208 possible pharmacy-formulation combinations (8 pharmacies × 26 formulations). For 172 (83%) of the 208 pharmacy-formulation combinations, the March 2022 price was within 20% of the October 2021 price. Across pharmacy-formulation combinations, the price change over time ranged from − 76 to + 292%. For 12 (46%) of the 26 formulations, at least one pharmacy with the lowest price in October 2021 no longer was the least costly in March 2022. For one formulation (dronabinol tablets), the least expensive pharmacy became the most expensive, with an absolute and relative price increase of a fill of $22 and 85%. Conclusion For almost half of formulations studied, at least one pharmacy with the lowest price was no longer the least costly a few months later. The lowest price for a formulation (across pharmacies) could also change considerably. Thus, even if a patient accesses the least expensive pharmacy for a medication, they may need to re-check prices across all pharmacies with each subsequent fill to access the lowest prices. In addition to safety concerns, directing medications to and accessing medications at multiple pharmacies can add time and logistic toxicity to patients with cancer, their care partners, prescribers, and pharmacy teams.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The least costly pharmacy for cancer supportive care medications over time: the logistic toxicity of playing catch up

Etteldorf

Sedhom

Rotolo

et al. 2022

Support Care Cancer

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“…Given the unique epidemiological, health systems, and sociocultural settings of Southeast Asian patients, local research that assesses family financial toxicity in the region is needed 36,44 . Most interventions aimed at reducing financial toxicity have been conducted in high‐income settings such as the US, 45,46 calling into question these interventions' generalizability to Southeast Asian populations, which is primarily composed of lower‐middle‐income populations. Importantly, further research must elucidate the many sociocultural factors at play, which may vastly differ from other parts of the world.…”

Section: Researchmentioning

confidence: 99%

The ripple effect: Cancer‐related financial toxicity for family members and caregivers

et al. 2022

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“…In line with this, local research exploring financial toxicity must be bolstered to accurately determine and appropriately respond to the unmet needs of patients in the region. Most interventions addressing financial toxicity have been piloted in high-income countries such as the United States, 13,14 and they may not necessarily be relevant to the financial and sociocultural milieu of patients in LMICs.…”

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confidence: 99%

Financial toxicities of cancer in low‐ and middle‐income countries: Perspectives from Southeast Asia

Eala

Dee

Ginsburg

et al. 2022

Cancer

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Patients with cancer in the United States are 71% more likely to experience a severe adverse financial event and 28% more likely to have past-due credit card payments than patients without cancer. 1 We write from Southeast Asia (SEA), a region of 660 million people with immense diversity in cancer epidemiology, health care systems, socioeconomic status, and culture, where cancer is a leading cause of death. The region is composed of 11 nations:

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Systems-Level Changes to Address Financial Toxicity in Cancer Care

Cited by 5 publications

References 11 publications

The least costly pharmacy for cancer supportive care medications over time: the logistic toxicity of playing catch up

The least costly pharmacy for cancer supportive care medications over time: the logistic toxicity of playing catch up

The ripple effect: Cancer‐related financial toxicity for family members and caregivers

Financial toxicities of cancer in low‐ and middle‐income countries: Perspectives from Southeast Asia

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