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Impact of Insurance Type and Cost Sharing on Equity in Access to Oral Anticancer Medications for Blood Cancers

Dr. Doshi

Jalpa Doshi


Perelman School of Medicine at the University of Pennsylvania

Project Term: June 1, 2023 - May 31, 2026

This project will evaluate the association of insurance type with insurer rejection and patient abandonment of new OAM prescriptions for blood cancers, overall and by sociodemographic factors. It will also evaluate the association of cost sharing with patient abandonment of OAM prescriptions for blood cancers and conduct simulations under alternative cost sharing scenarios to inform policy reform proposals among commercially insured enrollees. Finally, the study will evaluate the effect of cost-sharing reductions under the Inflation Reduction Act on patient abandonment of new OAM prescriptions for blood cancers among Medicare Part D enrollees, overall and by sociodemographic factors.

Lay Abstract

Increases in the number of FDA-approved oral anticancer medications (OAMs) to treat blood cancer have improved quality of life and survival rates. However, the high price of these drugs makes treatment extremely expensive, pointing to the importance of adequate insurance coverage. Even with insurance, many patients face barriers to OAM access such as high out-of-pocket costs and bureaucratic barriers (e.g., prior authorization, step therapy, and other utilization management strategies) that can result in treatment delays and/or abandonment. Knowledge is limited on the prevalence of these barriers and the rates of OAM delays and abandonment among blood cancer patients. This study will use a large national dataset to examine these factors across insurance types and to identify whether these access barriers are worse among vulnerable populations such as racial/ethnic minority patients. By including blood cancer patients with all insurance types (including the uninsured), study findings will provide strategies for improved OAM access that can be enacted at the state and federal level. The study will also examine how recent legislative changes from the Inflation Reduction Act (IRA) to the structure of the Medicare drug benefit impact these barriers.

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