Relationship between out-of-pocket spending and drug value for oral oncolytics reimbursed by commercial insurers: 2007-2014.

Abstract

6524 Background: With total and out-of-pocket (OOP) spending for oral oncolytics rising, there is increased interest in choosing oncology treatments based on their clinical value relative to cost. We sought to determine if OOP spending varied for higher versus lower-value oral oncology drugs reimbursed by commercial insurers. Methods: This was a retrospective analysis of commercial insurer prescription drug claims filed between 2007-2014 for 13 oral oncolytics approved before 2009. We calculated mean monthly OOP payments for each patient. We then categorized oral oncolytics by their overall and progression-free survival benefits for each FDA-approved indication, using evidence from published studies. We assessed the relationship of survival benefit with mean monthly OOP payment, adjusting for demographic and plan characteristics. Results: Our population included 44,109 patients ages 18-65 (mean age = 52.5 years, SD = 9.4 years) with a cancer diagnosis who filled 731,261 prescriptions. The most commonly represented oncolytics were imatinib (37.4% of fills) and lenalidomide (17.7% of fills). Approximately 57.6% of fills were for drug-indication pairs with an overall survival benefit of 5+ months. In adjusted analyses, there was no significant difference in mean monthly OOP payment between drugs without evidence of benefit and those with 0-5 months progression-free survival benefit or 5+ months of overall survival benefit (p > 0.05). Meanwhile, drugs with 5-10 months progression-free survival benefit or 0-5 months overall survival benefit had higher OOP payments than those without benefit (p < 0.01). Conclusions: OOP payments for oral oncolytics were not clearly related to indication-specific value. This suggests that despite increased attention to value- and indication-based drug pricing, cost-sharing for oral oncolytics does not currently reflect these goals.