Impact of Pharmaceutical Prescription Assistance Programs on the Care of Patients with Chronic Myeloid Leukemia in a Safety Net Hospital

Introduction:

The ever-rising cost of the oncology prescription drugs not only impacts the global cost of cancer care, but also affects the individual patient's financial toxicity, compliance, and outcomes. In safety-net setting, where the quality and quantity of care can be limited by the institution's budget, Prescription Assistance Programs (PAPs) are critical to patient care. Navigating the application process for these programs can be challenging for patients, especially for minorities and those with low health literacy. We looked at a pharmacy-run service for PAP enrollment at our safety-net hospital for patients diagnosed with chronic myeloid leukemia (CML).

Methods:

A total of 113 patients with CML who were receiving care at Parkland Health and Hospital System in Dallas, Texas, between January 2018 and December of 2019 were identified. Our pharmacy-run PAP service utilizes medication access technicians to complete PAP application packets for oncology patients. Patient records were reviewed to identify the payor mix, the choice of tyrosine kinase inhibitor (TKI), and number of prescriptions filled during the study period. Cost estimates are based on best advertised price for the individual drugs. For imatinib, cost estimate was based on the generic form.

Results:

Of the 113 CML patients, 78 did not have insurance. The majority of patients were Hispanic (61%); 19% were Black. In 62 patients (55%), English was not the primary language. TKIs used in first-line (insured vs uninsured) were: imatinib (49% vs 46%), dasatinib (31% vs 49%) and nilotinib (11% vs 5%). All uninsured patients were enrolled in Prescription Assistance Programs (PAP). The average time from diagnosis to application approval by the pharmaceutical companies was 23 days. Patients on average received the drug shipment 7 days after application approval. Uninsured patients received a total of 623 months' supply of their TKIs during the study period. Of these, only 7 were covered by the institution, most commonly to allow timely initiation of treatment while the PAP application was being processed. The estimated medication cost for the uninsured patients over the study period was $5.4m, of which $93k (2%) was covered by the institution.

Conclusion:

Our pharmacy-run PAP service allowed for rapid enrollment of all uninsured patients in pharmaceutical free drug programs and significantly reduced the cost of CML care for the institution. An expansion of this service to allow better utilization of copay assistance programs for insured patients can impact the financial toxicity associated with TKIs and is currently being planned.