Integrated Health-System Specialty Pharmacy Support in Reducing Financial Toxicity of Oral Oncolytic Therapy

Presenter: Tanner Buchanan, Pharmacy Intern, University of Rochester Specialty Pharmacy, Rochester, NY

Co-Authors: Shannon Gowen, PharmD, Clinical Pharmacist, and Jerimiah Moore, PharmD, Clinical Pharmacist, University of Rochester Specialty Pharmacy, Rochester, NY

BACKGROUND: Oral anticancer therapy has become an increasingly popular alternative to traditional cancer regimens. As a result, patients have fewer office visits and less medication complications.¹ Although oral therapy is more convenient than intravenous therapy, oral medications come with significant financial barriers, which can limit patient access to, and affect the success of, these regimens.^1,2 In 2019, pharmacists from the University of Chicago Medical Center published an article in the Journal of Managed Care & Specialty Pharmacy that drew attention to the increasing need for an oncology specialty pharmacy to assist with reduced financial toxicity, by securing copay assistance for patients with cancer.³ They reported the results of their study showing that of 75 patients who received financial assistance, the cost-savings ranged from $5 to $13,138 per prescription claim.³ The high cost burden of oral anticancer medications may result in limited access to therapies, delays in starting treatment, and therapy abandonment.¹

OBJECTIVES: To determine the total financial support obtained by University of Rochester Specialty Pharmacy to help relieve patients from financial toxicity associated with oral oncolytic medications, and to determine the percentage of patients receiving copay assistance support, including independent foundations, manufacturer copay cards, and social work funding.

METHOD: This retrospective quality improvement project was granted Institutional Review Board exemption. We reviewed prescription claim data for patients who were prescribed an oral oncolytic through the University of Rochester Wilmot Cancer Institute between July 20, 2020, and July 20, 2021, and filled at our specialty pharmacy. The data were analyzed using descriptive statistics.

RESULTS: Over a 1-year period, a total of 12,310 prescription claims were reviewed for 1746 patients who filled an oral oncolytic through our specialty pharmacy. Of these patients, 932 (53.4%) patients received financial assistance, including 25% of patients who used copay assistance from independent foundation grants, 11.2% who used manufacturer copay cards/vouchers, and 17.2% who received financial support through internal social work funding. After optimizing New York State Epic enrollment, our specialty pharmacy patients received $4,403,513.73 in financial assistance, including $2,704,845.41 that was obtained either from independent grants (38.5%), manufacturer copay card/vouchers (41.8%), or the University of Rochester internal social work funding (19.7%). Before financial assistance was obtained, the average patient copay for foundation/grant, copay card, and social work was $328.65, $1730.70, and $807.05, respectively. After financial assistance was obtained through this project, the average patient copay was $0.80, $46.48, and $96.23, respectively.

CONCLUSION: These relatively low copays with our financial assistance program for high-cost oral anticancer therapy highlight the value that an integrated health-system specialty pharmacy has in the care of patients with cancer when financial assistance is obtained.

1. Zullig LL, Wolf S, Vlastelica L, et al. The role of patient financial assistance programs in reducing costs for cancer patients. J Manag Care Spec Pharm. 2017;23:407-411.
2. Niccolai JL, Roman DL, Julius JM, Nadour RW. Potential obstacles in the acquisition of oral anticancer medications. J Oncol Pract. 2017;13:e29-e36.
3. Farano JL, Kandah HM. Targeting financial toxicity in oncology specialty pharmacy at a large tertiary academic medical center. J Manag Care Spec Pharm. 2019;25:765-769.