Multiple Factors Lead to Delayed Receipt of Oral Anticancer Drugs

Financial- and insurance-related factors were found to delay the receipt of oral anticancer drugs (OACDs), sometimes for 14 days or longer from the date of the prescription, according to a study presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago.

Coordination between clinicians, payers, specialty pharmacies, and financial assistance (FA) groups is needed to prescribe and deliver OACD prescriptions to patients. The factors associated with delayed receipt of OACDs are unknown; therefore, Daniel O’Neil, MD, of Columbia University Medical Center, in New York, New York, and colleagues sought to identify the variables that may prevent timely receipt of AOCD prescriptions.

The researchers prospectively collected data on all new OACD prescriptions from the medical oncology practice at the Herbert Irving Comprehensive Cancer Center from January 1, 2018, to December 1, 2018, including demographic, insurance, and clinical information on patients; date of prescription; date of drug delivery; and staff interactions with payers and FA groups.

Initial drug approval dates, approved indications, and average wholesale price were obtained from US Food and Drug Administration (FDA) labels and Micromedex. Multivariable linear and logistic regression were used to determine factors associated with the number of days from prescription to receipt of OACD.

The investigators evaluated 510 OACD prescriptions during the study period. The most common drugs prescribed were capecitabine (90 [18%]), abiraterone (45 [9%]), palbociclib (35 [7%]), and osimertinib (28 [6%]). Eighty-four (16%) of the prescriptions were never filled. Median number of days to receipt for the remaining prescriptions was 8 (IQR 5-13): 193 prescriptions (46%) were received in 7 days or less, 145 (34%) in 8 to 14 days, 65 (15%) in 14 to 28 days, and 23 (5%) were received more than 28 days after prescription.

Linear regression showed time to receipt of OACD was associated with having commercial primary insurance (P =.02), pursuing financial aid (P ≤.001), prescribed drug received FDA approval less than 2 years prior (P =.008), off-label use (P =.03), and estimated drug cost (P =.002). No association was seen between time to receipt and patient age or prior authorization.

Logistic regression comparing receipt of OACD in 14 or fewer days compared with more than 14 days was associated with financial aid (odds ratio [OR] 3.17; 95% CI, 1.78-5.65), FDA approval within 2 years (OR 3.52; 95% CI 1.31-9.45), and off-label use (OR 2.30; 95% CI 1.18-4.50).

These findings showed that more than 20% of new oral chemotherapy prescriptions were received 14 or more days from the date of prescription. In addition to financial and insurance issues, cost and recent FDA approval were associated with longer delays to receipt of OACDs.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

O’Neil D, Accordino MK, Wright JD, et al. Delay in receipt of newly prescribed oral anticancer drugs. Poster presentation at: 2019 ASCO Annual Meeting; May 31 to June 4, 2019; Chicago, IL. Abstract 6541.