A recent article described a quality improvement project at the oncology specialty pharmacy unit within the University of Chicago Medicine.
A retrospective analysis of prescription claims shows the importance of an oncology specialty pharmacy team in ensuring access to financial assistance and reducing financial toxicity, which otherwise might hinder access to therapy.
A recent article in the Journal of Managed Care and Specialty Pharmacy described a quality improvement project at the oncology specialty pharmacy unit within the University of Chicago Medicine (UCM).
Financial toxicity causes patients financial distress; it is already known that patients with a cancer diagnosis are 2 and a half times more likely than those without cancer to file for bankruptcy. High out-of-pocket (OOP) costs can result in treatment delays, treatment abandonment, and higher overall costs of care. While the shift to oral anticancer medications (OAMs) and supportive care medications helps patients live longer, these changes present new challenges, including high cost and barriers like obtaining prior authorization.
This study sought to evaluate patient OOP costs after enrollment in manufacturer patient assistance programs, copay cards, and foundation grants. Researchers analyzed prescription claims from January 2017 to June 2017. The primary outcomes included the number of patients enrolled in manufacturer patient assistance programs, receiving copay cards, and receiving foundation grants, along with the total dollars applied to pharmacy claims. The secondary outcome was the average days to approval of a foundation grant.
Claims were included if oncology prescriptions were filled at UCM Specialty Pharmacy. Claims that were not filled at UCM Specialty Pharmacy due to out-of-network insurance were not included, as were prescriptions that were part of a direct-ship patient assistance program from the manufacturer.
Results showed that 75 patients received financial assistance, with a total cost savings of $314,857. Financial assistance was most frequently applied to the following medications: pegfilgrastim, dasatinib, abiraterone, filgrastim and the biosimilar filgrastim-sndz, palbociclib, venetoclax, and ruxolitinib.
The cost savings of these interventions ranged between $5 and $13,138 per prescription claim.
The average days from date of insurance approval to date of financial grant approval was 1.2 days. There were 63 total claims for foundation grants, with a total patient cost savings of $57,404. The total number of unique patients enrolled in copay cards was 20 patients. The total patient cost savings was per unique patient was $2870. The overall mean costs savings per claim was $911 for foundation grants, with an average reduction of 99.9% on OOP costs for patients.
Manufacturer Patient Assistance Programs
There were 25 total claims for manufacturer patient assistance programs, with a total patient cost savings of $216,037. The total patient cost savings per claim was $8642. There were 14 unique patients enrolled in manufacturer patient assistance programs, with a total cost savings per unique patient of $15,431. The overall mean patient cost savings per claim was $8642.
There were 65 claims for copay cards, with a total patient cost savings of $41,416. For 41 unique patients, there were total cost savings per patient of $1010. The overall mean cost savings per claim was $637 for copay cards, with an average reduction of 88% on OOP pocket costs for patients.
An oncology specialty pharmacy practice model can play a role in decreasing financial toxicity, as pharmacists and pharmacy technicians provide ongoing patient support by ensuring access and affordability with financial assistance programs, the authors wrote. They can perform benefits investigations, assess patient OOP responsibility, and enroll patients in such programs to alleviate the high cost burden of OAMs and prevent patients from stopping treatment.
Farano JL, Kandah HM. Targeting financial toxicity in oncology specialty pharmacy at a large tertiary academic medical center. J Manag Care Spec Pharm. 2019;25(7):765-769. doi: 10.18553/jmcp.2019.25.7.765.