Expert: Implementing Cost-Effective Care Is Essential to Mitigate Financial Toxicity
Using biosimilars and generics as well as getting patients connected with manufacturer copay assistance or grant programs can reduce their out-of-pocket costs.
Pharmacy Times® interviewed Chelsee Jensen, PharmD, BCPS, senior pharmacy specialist at Mayo Clinic, about the cost of cancer care. She emphasized that the Inflation Reduction Act can be significant in lowering the costs of certain drugs for patients. It is also important to be aware of manufacturers who are trying to get around the act, she noted, because it can help health care professionals better understand the possible impacts on patients.
Jensen was one of several panelist speakers at the discussion “The Cost of Cancer Care,” part of the event “Elevating Cancer Care Delivery: Thinking Outside the Box.” The event, which was cohosted by Institute for Value Based Medicine® (IVBM) and Mayo Clinic, created a unique forum where experts discussed their experiences and insights on the implementation of value-based care that is relevant for both oncology and population health stakeholders.
Pharmacy Times: How have you worked to support patients when managing the cost of cancer care and/or mitigate financial toxicity from the cost of treatments?
Chelsee Jensen, PharmD, BCPS: So, from my standpoint as a formulary manager, implementing cost-effective care wherever we can—[such as] lower cost biosimilars [and] generics—in any space that we can is important that we directly pass through to the payer and, therefore, to the patient, usually through reduced coinsurance.
At our institution, I'm a little bit less involved, but I know we are really trying to be involved with the patient, especially if there's a financial toxicity concern. [We're] trying to get them hooked up with manufacturer copay assistance or grant programs to reduce their out-of-pocket costs, just so they want to proceed forward with treatment, because we do want to make sure that we're delivering treatment to patients, but we have to be mindful of affordability and what that might do. Not only to the patient, but to their whole family.
Pharmacy Times: What is your view on key issues that will impact financial toxicity for patients being treated for cancer in 2025?
Jensen: I would say the Inflation Reduction Act (IRA) has hope. We know that out-of-pocket coinsurance will be reduced for Medicare patients, which will make transition of certain agents to the outpatient setting much more feasible...We know that coinsurance has been reduced for—I think—up to 64 drugs now through Medicare Part B negotiations; however, can we truly expand that? I know there's a lot of litigation going on, so how far the IRA moves is yet to be seen. Also, we know that manufacturers are coming up with unbranded agents or kind of doing other tactics to get around the IRA, and I think we have to be very mindful of that and be aware of how that's going to impact truly reducing the cost to patients.
