San Diego—For health plans attempting to cut costs, instituting higher out-of-pocket (OOP) payments for patients taking oral oncology drugs may not be a prudent solution, according to research presented at the AMCP’s annual meeting. In a poster presentation at the meeting, researchers from Prime Therapeutics (Eagan, MN) revealed that when handed an OOP payment above a certain threshold, patients were 3 times as likely to abandon their initial drug therapy.
The researchers examined a database of 7 million Blue Cross and Blue Shield members from the Midwest and South who were newly prescribed an oral oncology medication between July 2006 and June 2008. After reviewing members’ claims, the researchers placed them into 4 OOP expense groups—$0 to $100, $101 to $200, $201 to $500, and greater than $500. They then calculated the percentage in each group that abandoned therapy.
The research team found that during the selected time frame, 1909 members began treatment with oral oncology drugs and 163 of them (8.5%) abandoned therapy. Although most of the patients (1562 [81.8%]) had an OOP expense of $0 to $100, those with an OOP expense of $200 or more were 3 times more likely to abandon therapy than patients in the lower 2 groups. Neither age nor gender was associated with the likelihood of abandonment.
According to lead researcher Catherine Starner, PharmD, BCPS, CGP, health plans should consider the study findings when determining their pharmacy benefits and should especially think about instituting a maximum OOP member expense per claim. “Patients who do not adhere to their medication regimen are at risk for serious medical and health complications, which could result in substantial medical or hospitalization expenses for both the patient and insurer,” Dr Starner said. Chyongchiou Jeng Lin, PhD, an associate professor of Health Economics in the Department of Family Medicine at the University of Pittsburgh who was not affiliated with the study, adds that the study is especially important given the large number of cancer patients prescribed oral oncology medications.
