Oral cancer drug parity: Opportunities for better patient access and affordability

Increase of Oral Agents Transform the Meaning of Cancer Treatment at Home

About a decade ago, when considering what home care looked like for the patient with cancer, one might picture a hospital bed in the corner of the room and a nurse coming to provide hospice or palliative care. Others might picture central line care maintenance after checking the patient’s continuous chemotherapy infusion pump. The increase of oral agents as part of cancer treatment plans significantly changes the landscape of home care, offering independence and flexibility in where treatment is received.

In 2015, oral agents represented 50% of the FDA approved antineoplastic agents, and accounted for 25% of antineoplastics currently in the pipeline. First-line therapy for several oncologic indications consist of oral agents. Oncology clinicians and law makers are challenged with optimizing patient outcomes in the wake of this influx.

Weighing the Opportunity with the Challenge

The fact that patients self-administer their oral anticancer medications adds a layer of complexity to treatment plans. Yes, patients are able to take pills at home, see a reduction in the need for leaves of absence from work, maintain independence and optimize quality of life. But it is imperative that oncology clinicians work with patients and caregivers to overcome the challenges associated with oral therapy. The financial burden of oral medications can be daunting at best, prohibitive at worst. Wide access to patient assistance programs and prescription coverage is critical for patients to be able to reap the benefits of oral agents.

Currently oral agents are covered under prescription plans, but may carry extensive out of pocket costs. The Oncology Nursing Society (ONS) and sister oncology professional organizations are strong advocates for the Cancer Drug Parity Act, HR 1730, which would ensure federal regulation of out-of-pocket costs for parenteral and oral anticancer agents, making them similar and putting less financial burden on those prescribed oral agents. Work has been done to level this playing field, but it remains a state issue, leaving those covered by federal health plans vulnerable to disparity. The implications associated with this disparity are that patients prescribed intravenous or subcutaneous agents may be financially responsible for a considerably lesser amount than those prescribed oral agents. Consistency across the nation for those undergoing treatment with cancer is critical, especially as oral agents become first-line therapy for a growing number of malignancies.

Tales from the Trenches

Oncology nurses are critical to assessing one’s adherence to complex dosing regimens associated with oral antineoplastics. They hear all of the challenges—some large, some small—that interfere with the ability to take medications as prescribed. In some instances, the financial burden is so heavy, patients report cutting pills in half to make their medication supply last twice as long. Others hesitate to report the severity of experienced side effects due to the fear of being removed from therapy. Instead, they dose-reduce or skip doses until the symptoms resolve.

Through communication and thorough assessment, oncology nurses learn when patients and their caregivers are taking liberties to adjust doses in an attempt to combat some kind of struggle they encounter—financial, or otherwise. The results of such actions can be detrimental to their health and disease-related outcomes.

Oral therapies are revolutionizing cancer care in more ways than could have ever been predicted. But in order for the full benefits of this revolution to be recognized, providers, clinicians, pharmacists, industry and policymakers must address the associated challenges to optimize access to care and ensure affordability regardless of route of administration.