Patient out-of-pocket and insurer payment decisions for bevacizumab for metastatic colorectal cancer: A Canadian analysis

Abstract

6576 Background: Like many health care services in Canada, intravenous (IV) cancer therapies are typically funded publicly through hospitals and provincial cancer agencies. Delays may be encountered between regulatory approval and public funding of new drugs. IV drugs are not routinely covered through private insurance (PRI) plans, requiring patients to appeal for special consideration, including employer exceptions or pay cash. Uncertainty of drug funding may create challenges for physicians and patients when discussing treatment options. The Roche Patient Assistance Program (RPAP) provides reimbursement navigation, copay/financial assistance and access to infusion clinics. This observational study examines patient access to bevacizumab (B) in the absence of public funding. Methods: An analysis of the RPAP database for the period of July 2006 to August 2008 was conducted assessing patients enrolled, insurance status, approval rates, and access to B. Receipt of treatment with B was evaluated according to insurance coverage. Results: A total of 877 patients accessed the RPAP for treatment with B. 647 (74%) had PRI and 230 (26%) were uninsured. Of PRI patients, 310 (48%) were approved coverage and 337 (52%) were denied. 204 patients (65%) with approved PRI coverage received B therapy. Of patients with PRI but denied coverage for B, 135 (40%) elected to pay for B. Of patients with no PRI, 120 (52%) paid for B. Of all patients with no coverage for B (no PRI or denied PRI), 255 patients (45%) elected to pay for B. Conclusions: In a public healthcare environment, when B was not publicly funded, approximately half of patients without any PRI coverage who accessed the RPAP were willing to pay for B. Although private insurers state IV drugs are not plan benefits, almost half of patients were able to obtain B coverage. A conventional analysis of willingness-to-pay should be conducted to better understand reasons behind patient and private insurer decisions observed in this study. Further research should also be conducted to determine whether results can be generalized to other unfunded anticancer agents within the Canadian health care system. [Table: see text]