By Marina Sampanes Peed
Traditionally, cancer treatments were delivered by infusion in clinics and hospitals. Today, many are patient-administered with 30% expected to become available in pill/capsule form in the near future. MPN patients routinely self-administer Hydroxyurea, Pegylated Interferon-a, or Ruxolitinib.
At our Atlanta MPN Patient Education program, Jennifer Powers, PharmD, of Walgreens Specialty Pharmacy explained what these changes mean for MPN patients today. Cancer drugs are classified as “specialty medications” and their coverage varies by prescription drug plan. They are typically not available through retail pharmacies. And the cost to patients varied widely.
Check Your Drug Plan
Dr. Powers urges everyone to look at the new prescription drug plans before Open Enrollment season each year. Make sure the medications you expect to require are covered in your plan. Both public (Medicare/Medicaid) and private, commercial drug plans are subject to changes. The name of the plan and monthly premium may look the same, but the drugs covered, dollar amount covered, and co-pays may change. Their pharmacy contracts may also change. Each plan has tiers of medications, with different levels of coverage. The tier level of a drug varies by pharmacy, as do the pricing and financial requirements. Some require multiple prior authorizations, continued follow-up, and appeals for off-label use.
More Hoops for Patients
Before you can receive the specialty medication prescribed by your doctor, the Prescription Benefits Manager (PBM) that administers the plan must issue a Prior Authorization. It is quite common for them to reject the initial treatment request, so an appeal must be filed. If the drug is not on their “formulary” (list of drugs covered), it often takes more than one appeal before treatment is approved. Once approved, the medication is ordered and shipped to the specialty pharmacy, then delivered to the patient.
Often refills must also go through the review, denial, and appeal process. With new treatments coming to market and “off-label” use of medications for other illnesses, the process adds to patient fatigue and stress.
Your pharmacist will work with your doctor and assist you through this process.
Financial Toxicity is a Known Side Effect
Financial toxicity comes from the direct costs associated with treatment. There is little room in most personal budgets to absorb ongoing, expensive treatment. Out-of-pocket medical costs (deductible, co-pay, co-insurance) as a percentage of income for managing chronic illness can lead to credit card debt, medical debt, trouble paying for other necessities (housing, food).
The expense of treatment is shown to impact several health related outcomes: treatment compliance; quality of life; and response to treatment.
Some Financial Assistance is Available
There are several Prescription Assistance Programs (PAP) available to patients, each with its own requirements and limitations. The main eligibility criteria include: diagnosis; funding availability; existing insurance coverage; patient’s finances; and FDA approval or off-label use.
Dr. Powers encourages patients to appeal if their application is denied. Some are determined by the prior year’s tax return information; if the current financial situation is worse, explain it in the appeal. If you exhaust a grant, apply again.
(See the list of resources at the end of this article.)
Importance of Medication Adherence
While it may seem obvious, taking medicine as prescribed is important to manage disease. Dr. Powers highlighted four common challenges for patients:
- Affordability: some patients “stretch” the dosing by taking a lower dose than prescribed or skipping a dose regularly because of cost. Some patients buy pills as they have cash available.
- Unpleasant side effects: some patients stop taking a medication because of initial side effects or ongoing side effects that affect their quality of life.
- Incorporate with Lifestyle: it is important to find the right medication schedule for you. Some are best taken at night so side effects are less noticeable; some may be easier to manage when taken a certain day of the week.
- Access to Information: simply knowing what a drug is doing for you, what can interfere with its effectiveness, or how to alleviate side effects can help a patient comply with the treatment plan. Learning about financial and social resources can also help.
Travel Planning Tips
When planning to travel, don’t wait until departure day to think about your prescription medications.
- Ask your pharmacist about “vacation overrides” to be sure you have enough medicine while away from home.
- Check if you need a new prescription or a refill.
- If you need medication sent to a temporary location, make arrangements before you leave home.
- Check if you need a doctor’s note regarding your diagnosis and treatment to take with you.
- Get additional packaging, supplies, and ancillary medications.
- Remember a cooler and ice packs if needed.
- Check TSA / airline rules about carry-on injectable medications.
Co-Pay & Insurance Assistance Resources
PAN Foundation has co-pay assistance program for Myeloproliferative Neoplasms and many other diseases.
Good Days is a co-pay assistance organization and Myeloproliferative Neoplasms are covered.
HealthWell Foundation: http://www.healthwellfoundation.org/
Partnership for Prescription Assistance: https://www.pparx.org/
Patient Advocate Foundation Co-Pay Relief Program: http://www.copays.org/
CancerCare Co-Payment Assistance Foundation: http://cancercarecopay.org/