Studies Examine High Drug Costs, Unnecessary Prior Authorizations as Barriers to Cancer Care

Out-of-pocket (OOP) drug costs and prior authorizations (PAs) can have negative effects on outcomes in cancer care, according to 2 new studies.

Both OOP costs and PAs for cancer drugs can result in barriers to patient access to timely and consistent care. The studies examined the effect of OOP costs for oral cancer therapy on overall survival and how collaboration between health systems and payers can streamline the PA process.

In the first study on OOP costs, 106 patients with stage 4 non-small cell lung cancer (NSCLC) were identified from the Washington State Surveillance, Epidemiology, and End Results (SEER) registry. Patients had mutations of epidermal growth factor receptor (EGFR+) and anaplastic lymphoma kinase (ALK+) genes and had at least 1 prescription for an oral tyrosine kinase inhibitor (TKI). Although oral TKI treatments are effective in this subset of patients, cost can be a major barrier to access.

According to the analysis, OOP costs of TKIs were linked to a lower number of these prescriptions and a shorter duration of therapy. Additionally, the study showed that one-quarter of patients in Washington state with the highest median OOP costs were more than twice as likely to die after 3 months of starting TKI treatment (adjusted hazard ratio, 2.31; p=0.003) compared with all other patients in the study.

The second study focused on PAs in cancer care. To examine the effect of PAs on treatment delay and administrative burden, researchers from the Seattle Cancer Care Alliance (SCCA) reviewed imaging requests.

According to the findings, 94.8% of PAs for imaging studies were approved instantly or after the provision of additional information, 2.15% of requests were approved after a peer-to-peer review, and only 3% of PAs did not meet medically necessary criteria.

The researchers noted that the results demonstrate that the PA process can add unnecessary administrative burden and contribute to delays in patient care. Close collaboration between hospitals and payers can help eliminate this process and improve efficiencies, they concluded. Based on the analysis, the SCCA partnered with a large regional commercial payer to eliminate the need for PAs.

“SCCA uses an in-house tool to support clinical decision making,” principal investigator Tracy Wong, MBA, said in a press release. “However, most EHRs have the capability to embed clinical decision support that aligns with payers’ medical coverage policies, making this a relatively simple and scalable way to speed and improve care. This is what payers are asking for: the ability for providers to access the most up-to-date, evidence-based practice guidelines in real-time.”

Both studies will be presented at the American Society of Clinical Oncology’s upcoming Quality Care Symposium.

References

Goulart BHL, Unger JM, Chennupati S, et al. Effect of high patient out-of-pocket (OOP) cost for oral tyrosine inhibitors (TKIs) on survival in EGFR and ALK positive stage IV non-small cell lung cancer (NSCLC) [abstract]. American Society of Clinical Oncology. https://meetinglibrary.asco.org/record/178873/abstract. Accessed September 4, 2019.

Sharma M, Gustafson A, Jagels B, et al. Collaboration with commercial payor to eliminate prior authorization [abstract]. American Society of Clinical Oncology. https://meetinglibrary.asco.org/record/178870/abstract. Accessed September 4, 2019.

Studies Highlight Barriers of Drug Costs and Prior Authorizations [news release]. American Society of Clinical Oncology. https://www.asco.org/about-asco/press-center/news-releases/studies-highlight-barriers-drug-costs-and-prior-authorizations. Accessed September 4, 2019.