Out-of-Pocket Costs and Prescription Abandonment of Novel Oral Anticancer Agents


Key Points

  • Prescription abandonment significantly increased with increasing out-of-pocket costs.
  • Claim reversal and delayed initiation also significantly increased with increasing out-of-pocket costs. 

In a retrospective claims-based study reported in the Journal of Clinical Oncology, Doshi et al found that higher out-of-pocket costs were associated with increased rates of prescription abandonment for novel oral anticancer agents.

Study Details

The study involved data on 38,111 patients from 2014 to 2015 from a large, proprietary, integrated Database (Symphony Health Solutions’ Integrated DataVerse) and included Medicare and commercial insurance enrollees with new adjudicated prescriptions for any of 38 oral anticancer agents. Rates of claim reversal (failure to purchase approved prescription), delayed initiation (reversal with subsequent fill of same agent within 90 days after adjudication), and abandonment (reversal with no fill of same agent within 90 days after adjudication) were analyzed. Logistic regression analysis was used to control for sociodemographic, clinical, and treatment characteristics to provide adjusted rates.

Rates of Abandonment

Adjusted rates of claim reversal increased with higher out-of-pocket costs, increasing from 13% among patients responsible for ≤ $10 to 67% among those responsible for > $2000; rates were 14%, 19%, 41%, and 54% among those in the $10.01–$50.00, $50.01–$100, $100.01–$500, and $500.01–$2,000 OOP groups. The overall abandonment rate was 18%, including 10.0% for the ≤ $10 group; 13.5% for the $50.01–$100 group; 31.7% for the $100.01–$500 group; 41.0% for the $500.01­–$2,000 group; and 49.4% for the > $2,000 group.

Abandonment rates remained similar after adjustment for use of alternative oral, injectable, or infusible anticancer drugs. Rates of delayed initiation were 3%, 4%, 6%, 9%, 13%, and 18%, according to out-of-pocket level. Rates of reversal, abandonment, and delayed initiation were significantly higher in the $50.01 to $100 out-of-pocket group and all higher out-of-pocket groups vs the ≤ $10 level (all P < .01). Similar associations were found in sensitivity and subgroup analyses by insurance type, pharmacy type, sex, and indication.

The investigators concluded, “Higher [out-of-pocket] costs were associated with higher rates of oral prescription abandonment and delayed initiation across cancers. Fiscally sustainable strategies are needed to improve patient access to cancer medications.”

The study was supported by Pfizer.

Jalpa A. Doshi, PhD, of the University of Pennsylvania, is the corresponding author of the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.