Predictors of Adherence to Oral Anticancer Medications: The Impact of Out-of-Pocket Costs

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: 

The JMCP 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. 

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