Specialty Pharmacy Eases Financial Burden for Patients on Oral Therapies for Hematologic Malignancies

Patients with hematologic malignancies often face high financial burden and may be dependent on Medicare and foundation grant assistance, according to an oral abstract presented at the 61^st American Society of Hematology Annual Meeting and Exposition.

Study author Erlene K. Seymour, MD, who presented the data, discussed how the Karmanos Cancer Institute (KCI) Specialty Pharmacy facilitated an efficient process for fast authorization and drug delivery to help decrease patient costs and speed up access to treatment.

Costs for novel oral therapeutics have been rising, which in turn place significant financial toxicities on the patients requiring these treatments, according to Dr Seymour. Assistance through co-pay cards or foundation grant funding can help offset some of the costs, “however obtaining this extra funding is quite complicated,” Seymour noted.

The study examined data from an established specialty pharmacy at KCI, which streamlines prior authorizations (PAs), determines patient cost-sharing, and then automatically applies for financial assistance. According to Seymour, the program consists of a team of 2 to 3 individuals: 1 pharmacist who fills the prescription, 1 pharmacist or pharmacy technician who performs PAs, and 1 assistant whose sole job it is to search and apply for grant funding and co-pay cards.

Using the KCI Specialty Pharmacy dataset, the authors conducted a retrospective review of patients who received prescriptions for hematologic malignancies between March 2018 and May 2019. High-cost therapies were defined as oral therapeutics with an average wholesale price of more than $10,000 per month. Patients were evaluated by drugs prescribed and insurance type, and information was gathered on insurer cost, final patient cost-sharing, cost covered by foundation grant assistance, and cost covered by manufacturer co-pay cards. The study also measured prescription written date to date of delivery to the patient for all new first-time prescriptions.

In total, 214 prescriptions among 100 patients were available for analysis. Drugs included in the analysis were imatinib, dasatinib, bosutinib, nilotinib, ponatinib, ruloxitinib, venetoclax, acalabrutinib, ibrutinib, ixazomib, midostaurin, gilteritinib, everolimus, vorinostat, and enasidenib.

Most of the patients had Medicare with or without supplemental insurance (52%), followed by private insurance (33%), and Medicaid (17%).

According to the results:

• Among all patients, 35% required additional financial assistance, and most of these were through foundation grant funding (26%) and manufacturer co-pay cards (9%).
• Medicaid patients did not require additional financial aid and have low cost-sharing given cost-sharing subsidies provided by Medicaid.
• Most of the patients requiring financial assistance were Medicare patients receiving foundation grant funding.
• Ten percent of patients did not receive additional assistance, despite having high cost-sharing exceeding $100 per prescription.

Claims costs for all prescriptions totaled just over $2 million, according to Seymour. For the most part, the majority of the cost was covered by insurers, with more than half covered by Medicare. Foundation grant assistance paid for approximately $52,950, manufacturer co-pay cards paid $8,486, and patient cost-sharing $23,818.

In addition, median times required for PA and delivery of drugs to patients were similar across insurance types. Most prescriptions received PA approval within 1 day and were delivered within 7 days, the data showed.

Overall, the analysis showed that patients covered by Medicare bear the most financial burden and have the highest need for financial assistance.

Seymour concluded that KCI Specialty Pharmacy acquired approximately $61,000 in financial assistance for patients, decreasing total patient copayments by 79%. These findings indicate that specialty pharmacy prescription and grant application processes can provide patients with fast, efficient drug delivery while decreasing costs.

Reference

Seymour EK, Daniel L, Pointer E, et al. 64 High dependence on Medicare and foundation grant assistance among patients with hematologic malignancies receiving novel oral therapeutics [abstract]. Presented at ASH Annual Meeting & Exposition. December 7, 2019. Orlando, Florida.