Dozens of oral chemotherapy drugs have been approved by the U.S. Food and Drug Administration over the past 2 decades and are now being prescribed in the treatment of many cancer types. However, most oral anticancer drug prescriptions require coordination between payers and providers, which can delay the time it takes for patients to receive treatment.
A study by Lichtenstein et al to be presented during the 2021 ASCO Quality of Care Symposium (Abstract 6) investigated the clinical and process-related factors associated with insurance-required prior authorization for oral anticancer drugs. Researchers found that 72% of these drugs required prior authorization and that prior authorization was associated with delayed time to drug receipt. Earlier intervention and new health policies are needed to reduce time to oral anticancer drug receipt, concluded the study authors.
Study Methodology
The researchers prospectively collected data on all new oral anticancer drug prescriptions for adult patients with cancer from January 1, 2018, to December 31, 2019. They collected patient demographic, medical, and insurance data; drug type, including hormonal therapy, chemotherapy, and targeted therapy; and specialty pharmacy interactions with payers and financial assistance groups, including prior authorization information. Time to drug receipt for patients receiving a new prescription was defined as the number of days from the prescription to patient receipt of the drug.
The researchers used multivariable logistic regression to separately assess factors associated with time to drug receipt and factors associated with prior authorization for patients who received a new oral anticancer drug.
Results
The cohort for both models included 883 patients who received 1,014 new oral anticancer drugs. Of these prescriptions, 72.3% (n = 733) required prior authorization. The median time to drug receipt was 7 days (interquartile range [IQR] = 0–142; 25% ≥ 14 days; and 5% ≥ 30 days). In unadjusted analyses, prior authorization was associated with insurance and drug type, and delayed time to drug receipt was associated with prior authorization and insurance type.
In a multivariable analysis, the researchers found that patients with Medicaid were more likely to require prior authorization compared to patients with Medicare (odds ratio [OR] = 1.93 [1.14–3.32], P = .03). In addition, patients prescribed targeted and hormonal therapies were more likely to require prior authorization than those prescribed oral chemotherapy (targeted therapy: OR = 3.33 [2.38–4.68], P < .001; hormonal therapy: OR = 4.26 [2.45–7.65], P < .001).
A separate multivariable analysis showed that prior authorization is associated with delayed time to drug receipt (OR =1.62 [1.18–2.24], P = .003) and that Medicaid is associated with a shorter time to drug receipt (OR = 0.59 [0.37–0.94], P = .03).
“The current process for obtaining oral anticancer drugs is complex and multifaceted. Seventy-two percent of delivered oral anticancer drugs require prior authorization, which is also associated with delayed time to drug receipt. Earlier intervention and new health policies are needed to reduce time to oral anticancer drug receipt,” concluded the study authors.
Perspective
Julie R. Gralow, MD, FACP, FASCO
“Quality cancer care means getting the right medication to the right patient at the right time,” said ASCO Chief Medical Officer and Executive Vice President Julie R. Gralow, MD, FACP, FASCO, in a statement. “By quantifying treatment delays associated with prior authorization of oral anticancer drugs, this study provides necessary information to remove obstacles to patients receiving their treatment as soon as possible.”
Disclosure: Funding for this study was provided by the National Institutes of Health. For full disclosures of the study authors, visit coi.asco.org.
