Biopharmaceutical innovation has led to an increase in the availability of oral medications to treat cancer. Oral anticancer medications (OAMs) are much more convenient for patients and avoid the inconvenience and administration costs of having to receive treatment at a doctor’s office or outpatient infusion center, allowing patients to self-administer oral medication at home. One challenge with OAMs however is nonadherence. Research has shown that almost half of patients on OAMs do not take their medications as prescribed.
New research conducted by the National Pharmaceutical Council (NPC), the Pharmacy Quality Alliance (PQA) and the University of Rhode Island further measured the impact of nonadherence. This study, published in the Journal of Managed Care & Specialty Pharmacy, closely examined which factors affect patient adherence. Although out-of-pocket costs are a leading barrier to patients taking their medications as prescribed, other factors such as clinical, sociodemographic and health-system factors also can affect adherence to OAMs.
This research identified the proportion of patients who were adherent to newly initiated OAMs across ten cancer types: blood, brain, breast, colorectal, liver, lung, ovarian, prostate, renal and stomach cancers. They found that overall adherence to OAMs was suboptimal - just slightly more than half of patients were adherent. For several cancer types, adherence was worse among patients with higher out-of-pocket costs, those who were hospitalized and those who received Medicare low-income subsidies.
According to this research, the affordability of OAMs is a top contributor to nonadherence. Oftentimes oral administration typically moves treatment to the pharmacy benefit instead of the medical benefit, which can result in high out-of-pocket costs and, in turn, nonadherence. In addition, these findings highlight health inequities and emphasize the importance of addressing financial barriers to improve patient access to OAMs.
Understanding these health system challenges can guide us in addressing barriers to improving access to medications for all patients, regardless of their socioeconomic status. Although several strategies to reduce patient out-of-pocket costs of OAMs have been implemented, such as state-specific oral cancer drug parity laws and the closure of the Medicare Part D coverage gap, the study findings suggest that these strategies alone may not be sufficient to reduce costs and improve access. Examples of potential solutions to ensure a more equitable benefit design include:
- Eliminating copay accumulator adjustment programs.
Under some health plans, direct payment assistance from a biopharmaceutical company to a patient counts toward a patient’s annual deductible and out-of-pocket maximum. Thus, the copay assistance accrues to the health plan rather than the patient it was designed to assist.
- Considering a holistic view of patient-cost sharing that includes its impact on patient, clinical and economic outcomes.
Results from prior research suggested a holistic view of patient-cost sharing after determining that the greater the magnitude of patient cost-sharing, the worse the adherence outcomes regardless of the condition, patient population, or type of cost-sharing.
- Educating employers on good practices to maximize the value of their benefit design.
Good practices for employers designing high-deductible health plans, such as offering or front-loading HSA contributions, can help improve access to and affordability of medications for enrollees.
- Considering frequently encountered barriers while seeking medication access. PQA and NPC developed the “Medication Access Framework for Quality Measurement,” which provides a patient-focused, holistic view of medication access and offers a structure to consider key opportunities for interventions and measurement to address medication access challenges.
The research findings highlight patient access barriers as well as health equity concerns. Policies addressing cost and access to OAMs and health-system strategies to mitigate these challenges can lead to improved adherence and ultimately better patient outcomes.