Why do 10% of cancer patients on oral meds stop taking them?

Ten percent of cancer patients failed to fill their initial prescriptions for oral anti-cancer drugs, according to a new study published jointly today in the Journal of Oncology Practice (JOP) and American Journal of Managed Care (AJMC)[, based on data] . . . from 2007 to 2009. . . .

The study, “Patient and Plan Characteristics Affecting Abandonment of Oral Oncolytic Prescriptions,” finds that patients were primarily abandoning their anti-cancer drugs due to two key factors: high cost-sharing and higher prescription activity. For example, claims with cost-sharing over $500 were four times more likely to be abandoned than claims with cost-sharing of $100 or less. Across the sample of prescription claims studied, Medicare coverage and lower income were also related to higher rates of abandonment when each were compared individually.

The study shows that while anti-cancer medicines offer benefits to patients, access to them is difficult due to high rates of cost-sharing. While 73 percent of newly initiated oncolytic patients had a cost-sharing amount of $100 of less, 16 percent required an out-of-pocket cost of greater than $500. The study found that the abandonment rate increased with cost-sharing amounts. Claims with cost-sharing above $500 had the highest abandonment rate – 25 percent – as compared with an abandonment rate of six percent for claims with cost-sharing of $100 or less.

(Source: presser from Avalere Health, which conducted the study.)

In the bad old days, most cancer meds were delivered through infusion therapy (chemotherapy), but a sizable chunk of those now in use, and likely more of those that are in the pipeline (25-35%) are oral meds.

IV meds administered in a health care facility are, generally speaking, not subject to the same level of cost sharing by patients now common for prescription medications.  Thus, the confluence of changes in drug therapy and changes in insurance coverage has led to a dangerous drop in medication adherence for cancer patients, due to higher out-of-pocket costs, even if the total cost of a given course of treatment is lower than the cost of a comparable course of IV chemo.

This should be understood intuitively, but apparently it is not.  A couple months ago, we were treated to another study showing that as high deductible health plans become more prevalent, use of preventive services declines.

The solution being adopted to deal with this latter problem, across many commercial plans as well as Medicare, is the elimination of copays for certain primary and preventive care services.  This makes economic sense to payors, even as it makes eminent sense for individuals as well.  For short money up front, expensive care down the road may well be avoided.

While we need not return to the bad old days of infusion therapy only for cancer meds, payors should examine the results of this study carefully and reconsider coverage rules.  Reducing out-of-pocket costs for these meds will increase adherence, and would likely reduce the incidence of complications and relapses requiring more expensive care . . . good for everyone.

(While we’re on the subject of cancer treatment, I would be remiss if I did not offer you the opportunity to sponsor my ride in the 2011 Pan-Mass Challenge — the two-day, 200-mile annual bicycle fundraiser for the Dana Farber Cancer Institute.  Please follow the link and give as generously as you can.  Tell your friends and neighbors.)

David Harlow
The Harlow Group LLC
Health Care Law and Consulting