Financial toxicity from the high cost of oral anticancer medication can be a barrier to patient access to treatment. In a study presented at the 2023 ASCO Quality Care Symposium, Gury Doshi, MD, and colleagues from Texas Oncology and The US Oncology Network sought out to find an answer to whether an integrated patient assistance process within a medically integrated pharmacy (MIP) lowers abandonment rates of oral anticancer medications. Medication prescription abandonment is defined as a patient making the decision not to fill a prescription. Nationally, abandonment rates are reported to be at 18%, and higher out of pocket costs are associated with higher risks of abandonment. MIPs have an integrated patient assistant process that is intended to lower the rate of prescription abandonment. 

The authors used the electronic health record (EHR) from their pharmacy’s dispensing system to review oral anticancer medication prescription data from January 2022 to December 2022. They defined EHR prescriptions that were sent electronically but did not have a corresponding dispense as having a barrier to fill. Within the barrier to fill category, cases were randomly chosen to identify why there was a barrier. The EHR also allowed the authors to find whether a patient had filled any other oral or injectable anticancer agent within 60 days because of a plan/insurance block, the patient’s choice, or the physician’s choice. They defined abandonment as patients not receiving prescribed treatment or an alternative treatment within 60 days of their written prescription date. 

Dr Doshi and colleagues found that physicians within the Texas Oncology organization had made 17,442 prescriptions within the specified timeframe. Of these prescriptions, 8460 were filled without extensive barriers, and 8982 were not filled at the Texas Oncology MIP. Within the prescriptions that were not filled at the Texas Oncology MIP, 2895 (32%) were placed under further review. Of these prescriptions, 1435 (49.5%) were routed to an external pharmacy to be filled, 827 (29%) of the patients experienced financial toxicity and needed free drug assistance, 72 (1.3%) were placed on an alternative therapy, and 15 (<1%) patients did not start their oral anticancer treatment. 

“National abandonment is reported as high as 18% largely due to high out of pocket costs,” the authors wrote. “The Texas Oncology MIP has a dedicated patient assistance team. Within the MIP, although 29% of patients had a financial barrier to fill, the prescription abandonment rate was <1%.” 

The authors concluded that he integrated patient assistance program helps patients with financial toxicity gain access to oral anticancer medications in the MIP. Dr Doshi and colleagues believe that for specialty cancer medications, the preferred option should be MIPs.
 

Doshi GK, Wilfong LS, Dave N, Hemmen W. Impact of medically integrated pharmacies on oral anticancer medication prescription abandonment. Presented at: the 2023 ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA, and virtual; Abstract 66.