Targeting Financial Toxicity in Oncology Specialty Pharmacy at a Large Tertiary Academic Medical Center

Abstract

BACKGROUND: Patients with cancer often face financial toxicity. They may face financial distress because of high out-of-pocket costs that in turn can result in delays in treatment, treatment abandonment, and higher overall costs of care, all of which can have have a negative effect on patient care. A specialty pharmacy practice model can play a role in decreasing financial toxicity.OBJECTIVE: To evaluate the patient out-of-pocket costs after enrollment in manufacturer patient assistance programs, copay cards, and foundation grants by an oncology specialty pharmacy at University of Chicago Medicine (UCM). METHODS: For this quality improvement project, a retrospective analysis of prescription claims from January 2017 to June 2017 was performed. The primary outcomes included the number of patients enrolled in manufacturer patient assistance programs, copay cards, and foundation grants, along with the total dollars applied to pharmacy claims. The secondary outcome was the average days to approval of a foundation grant. Inclusion criteria for this quality improvement project included prescriptions filled at UCM Specialty Pharmacy in the 6-month time frame for an oncology indication. Exclusion criteria were prescriptions that were not filled at UCM Specialty Pharmacy due to out-of-network insurance and prescriptions that were part of a patient assistance program where the medication was directly shipped from the manufacturer.RESULTS: In the 6-month time frame, 75 patients received financial assistance, with a total cost savings of $314,857. Financial assistance was most frequently applied to the following medications: peg-filgrastim, dasatinib, abiraterone, filgrastim and 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. CONCLUSIONS: This project demonstrates the importance of an oncology specialty pharmacy team in ensuring timely approval of a foundation grant and reducing financial toxicity, which can play a major role in access to therapy.

Impact of embedded medication assistance program specialists on medication access in outpatient oncology clinics

“…Farano et al examined prescription claims for patients who filled oncology specialty prescriptions over the course of six months at the University of Chicago Medicine (UCM) and found that financial assistance was most often applied to TKIs and hematopoietic agents. 11 The study described similar services to the support provided by the embedded MAP specialists in our study and found the average time for insurance and grant approval for patients at the UCM oncology specialty pharmacy was 1.2 days. Our study found a similar median turnaround time for insurance approval of 24 hours and copay assistance approval time of 18 hours.…”

Treatment Experiences with CDK4&6 Inhibitors Among Women with Metastatic Breast Cancer: A Qualitative Study

“…32 , 33 These programs are prevalent in oncology and estimated to cover 87% of all FDA-approved oncology drugs in the US, 33 but broad patient usage statistics for these programs are not known, nor are usage statistics specific to MBC. In retrospective studies in single cancer care institutions, usage estimates range from 12% of all oral oncolytic prescriptions 34 to 32% 35 and 36% 36 of oncology patients filling prescriptions for oral oncolytics at the specialty pharmacy.…”

Adherence to oral oncolytics filled through an internal health-system specialty pharmacy compared with external specialty pharmacies

“…10 Farano et al demonstrated the effectiveness of an oncology specialty pharmacy practice in an internal HSSP, reporting cost savings of over $300,000 to patients and an average time to insurance approval of 1.2 days for a cohort of 75 patients. 11 In a study by McCabe et al, patients who filled their oral oncolytic prescriptions at an internal HSSP had higher adherence as measured by MPR and PDC, compared with external specialty pharmacies (1.00 vs 0.75; P < 0.001 and 0.95 vs 0.70; P < 0.001, respectively). 9 Shorter TTT was also seen with internal HSSP services (6.85 vs 10.91 days; P = 0.102).…”