Study Sponsored by Community Oncology Alliance Identifies Barriers to Use of Oral Cancer Drugs, Proposes Solutions
A comprehensive study of oral oncolytic (anti-cancer) drug treatments revealed that while their use is increasingly common, cancer patients frequently face barriers to accessing oral drugs compared to those delivered intravenously in oncology practice settings.
Additionally, while oral anti-cancer drugs have advantages such as patient convenience, they require many crucial procedures by cancer treatment professionals -- including management of side effects and monitoring for patient compliance – but these key services are not reimbursed by Medicare or other payers. Because of cost, oral cancer drugs are frequently placed in the highest price tier, where the patient's out of pocket cost can be as much as 25-50% of the total cost.
"The new 'smart' oral cancer drugs, which are much more targeted and precise, are generally covered under patients' prescription drug plans, rather than under their medical plans," explained Patrick Cobb, M.D., president of COA and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana. "Patients are then left to foot a large portion of the bill - typically 25-50% of the cost. This can add up to thousands of dollars a year -- and sometimes thousands of dollars per month."
The study sponsored by Community Oncology Alliance was conducted by strategic healthcare advisory firm Avalere Health, which reviewed 2009 Medicare and private insurance payer formularies and coverage of 11 common oral oncolytics, looking at formulary placement, utilization management and patient cost sharing. Avalere also interviewed 54 oncology care-involved professionals to identify the most common barriers to oral oncolytics and potential solutions for addressing those barriers.