- High out-of-pocket costs and patient financial responsibility are keeping cancer patients from filling potentially life-saving prescriptions, according to a group of researchers from the Perelman School of Medicine at the University of Pennsylvania.
In a study published in the Journal of Clinical Oncology, the researchers found that drug abandonment – or not filling prescriptions – is increasingly prevalent in patients prescribed an oral cancer medication. Patients bearing more financial responsibility are less likely to fill their prescription, the analysis found.
Oral cancer drugs are beneficial because they are easier to take and can be taken at home, as opposed to intravenous cancer treatments. The medical field is seeing an increase in oral cancer drug development, the researchers said. But the high costs might be making the advancement moot as few patients are actually filling their prescriptions.
The researchers, who disclosed affiliations with Pfizer, looked at pharmacy data from between 2014 and 2015, investigating the prescription filling habits of 38,000 Medicare and privately-insured patients. The team stratified this information by claim reversal (failure to fill the prescription), delayed initiation (waiting to fill the prescription but doing so within 90 days), and abandonment (reversal with no fill within 90 days).
The team also looked at whether patients filled an alternative drug within 90 days.
In all, claim reversal rates ran from 13 to 67 percent, increasing with higher out of pocket cost brackets.
Abandonment rates reached an average of 18 percent, but when looking at higher out of pocket costs this rate increased. For $10 copays, abandonment rates were only 10 percent. But for those paying between $100 and $500 that rate reached 32 percent. And for patients paying $2,000 for their medications, the abandonment rate surged to nearly 50 percent.
This trend remained consistent across cancer type and severity. It also persisted after adjusting for patients accessing alternative drug solutions.
Delayed initiation as likewise greater in higher copay groups. Three percent of patients paying $10 delayed filling prescriptions. Eighteen percent of patients did the same when facing $2,000 copays.
These results indicate that more fiscally conservative solutions are necessary to foster medication adherence among cancer patients, the researchers concluded. The data used in the study revealed that one in eight patients had a $2,000 cost burden for their medication, but the research team predicted that this number is higher now.
If more patients have shifted up one cost bracket – from paying between $50 and $100 to between $100 and $500 – then the rate of abandonment would essentially double.
These findings are to be expected for many patients managing other chronic illnesses, the researchers said. Numerous studies have found that patients will delay or forgo filling prescriptions because the patient financial responsibility is too burdensome.
However, the Penn researchers said it is very disconcerting that this trend has emerged among cancer patients.
“Patients in our study were facing a new cancer diagnosis or a change in their disease that required a new treatment. Imagine leaving your doctor’s office with a plan, ready to start treatment, only to find you can’t afford it,” lead author Jalpa A. Doshi, PhD, a professor of General Internal Medicine in the Perelman School of Medicine at the University of Pennsylvania, said in a statement.
“It adds more stress at what is already a stressful and scary time,” added Doshi, who is also director of Value-Based Insurance Design Initiatives at the Leonard Davis Institute's Center for Health Incentives and Behavioral Economics.
Doshi and colleagues also stated that the findings that few patients seek alternative drug options indicate that providers need to discuss cost with patients early and often.
“This shows the importance of discussing financial barriers up front, during conversations about treatment options, even with patients who don’t raise concerns,” Doshi explained. “Patients may not be aware of how expensive their prescriptions will be, and physicians may not realize that a patient has opted not to fill the prescription.”
Providers need to establish trust with their patients to successfully hold these conversations, other medical professionals have asserted. According to Stuart Goldberg, MD, a practicing oncologist, finances and drug cost can be a sensitive topic among patients. Establishing trust is key to uncovering the reasons for limited medication adherence.
When treating his cancer patients, Goldberg flags high costs and asks patients how they are paying for their medications. If the patient seems unaware of the cost or has no payment plan in place, then he can infer that the patient hasn’t tried to fill the prescription.
When a patient does report cost and affordability issues, Goldberg has to manage another set of problems.
“There are a lot of different things that patients do to get around the costs,” Goldberg explained. “One of them, unfortunately, is saying ‘I’m doing okay on a pill a day, so maybe I’ll do okay on a pill every other day, and that way I don't have to pay as much for my drugs.’”
It is essential for oncologists to help patients identify the best possible drug at the most feasible price, Goldberg continued. This sometimes means compromising drug brand or type.
“If you don't take the medicine, it doesn’t matter. You can pick the best treatment but if the patient doesn’t pick it up from the pharmacy because they can’t afford it, that doesn’t help the patient,” Goldberg said. “If the patient does pick it up and she doesn't take the pill, that doesn’t help the patient either.”