Oral Oncolytics Abandoned by 1 of 10 Patients with Cancer

June 2011, Vol 2, No 3 - ASCO Annual Meeting

Chicago, IL—One of every 10 patients with cancer abandons new prescriptions for oral oncolytics, according to a study presented at the American Society of Clinical Oncology 2011 annual meeting and concurrently published in the Journal of Oncology Practice (Streeter SB, et al. 2011; 7:46-51).

Although the 10% prescription abandonment rate is in line with that of some other specialty drugs, it is higher than rates for chronic conditions, such as hypertension and depression. And, more distressing, the study results show that the rate climbs to approximately 25% among patients whose out-of-pocket (OOP) costs exceed $500.

Lee Schwartzberg, MD, Medical Director at the West Clinic, Memphis, TN, who participated in the study, presented the data.

“Our key finding is that 10% of patients who are prescribed their first oral oncolytic never even pick up the drug,” Dr Schwartzberg told Value- Based Cancer Care. “They don’t have the opportunity to get benefit from their treatment. Also, one quarter delay getting their prescription, sometimes as much as 90 days. Here are patients with advanced cancer who need therapy now, and they are not getting it.”

The study was based on an analysis conducted by Avalere Health using pharmacy claims from 2007 to 2009. Abandonment rate was calculated for the initial claim, in which abandonment was defined as reversal of an adjudicated pharmacy claim without a subsequent paid claim for any oncolytic (oral or intravenous) within the ensuing 90 days.

Regression analysis included patient demographics, plan type, drug type, cost-sharing, and concurrent prescription activity.

The following oral drugs were analyzed: capecitabine (Xeloda), imatinib (Gleevec), sorafenib (Nexavar), sunitinib (Sutent), lenalidomide (Revlimid), erlotinib (Tarceva), temozolomide (Temodar), and lapatinib (Tykerb)—all primarily prescribed for advanced disease.

High Cost-Sharing, Multiple Drugs Patients were primarily abandoning their cancer drugs because of 2 key factors: high cost-sharing and higher prescription activity. Claims with costsharing >$500 were 4 times more likely to be abandoned than claims with costsharing of ≤$100.

Although 73% of patients with new oncolytic prescriptions had a cost-sharing ≤$100, 16% of patients had OOP costs >$500.

The abandonment rate increased as OOP costs increased. Claims with costsharing >$500 had the highest—25%— abandonment rate compared with 6% for claims with OOP costs of ≤$100 (odds ratio [OR] 4.46; P <.001).

“Our study shows that many cancer patients are abandoning the medicine they need,” said Lauren Barnes, Vice President of Avalere Health. “With 45.5% of Medicare patients in our sample facing cost-sharing >$500 for their first anticancer drug, this is a Medicare quality issue of the first order.”

Many newer cancer drugs are oral agents that are usually self-administered without medical supervision. Although it is more convenient for patients, there may be trade-offs in terms of adherence and monitoring of side effects.

Patients were also more likely to abandon oral oncolytics if they had to take multiple medications. Abandonment rate in patients with ≥5 claims for noncancer medications in the previous month was 12% compared with 9% for patients with no claims in the previous month (OR 1.50; P <.001).

Medicare coverage and lower income were also related to higher rates of abandonment when each was compared individually. Patients with an annual income <$40,000 had an abandonment rate of 11%, decreasing to 10% for incomes between $40,000 and $75,000, and to 9% when income exceeded $75,000. Abandonment rates for Medicare claims were 16% versus 9% for those with commercial insurance.

The investigators suggest that the likelihood for abandonment of newly prescribed oral oncolytics increases for patientswith drug benefit designswith higher cost-sharing. Payers may need to consider these factors when designing a pharmacy benefit design for patients with cancer.

“The bottom line is that patients should have access to the most clinically appropriate care for their condition,” Dr Schwartzberg said. “We should not be creating obstacles to care for those who need it themost. This also tellsme that physicians are not asking patients if they are taking their drugs. We just assume they are.”