Many blood cancer patients never fill approved oral cancer drugs

A claims-based study of 12,134 Medicare and commercially insured patients with a new 2022 prescription for a specialty oral anticancer medication for blood cancers found that most prescriptions were initially rejected by insurers (64.9% Medicare, 84.0% commercial), often due to prior authorization or formulary restrictions. By 90 days, only 54.5% of Medicare patients and 45.5% of commercial patients had both obtained insurer approval and filled their prescription, and fill rates dropped sharply once out-of-pocket costs exceeded $175, falling to 21.6% among commercially insured patients with costs of $2,000 or more. The authors state these findings highlight access barriers from both payer-level restrictions and patient-level affordability challenges.

Most relevant for: Patients with blood cancers being prescribed specialty oral anticancer medications under Medicare or commercial insurance.

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