The CML study identified 5784 patients, aged 15 years or older, who were diagnosed with CML between 2007 and 2012 and whose insurance status was documented at diagnosis. The impact was most noticeable among younger patients, between age 15 and 64.

“Five years after CML diagnosis,” the study found, “patients with insurance at the time of diagnosis had an 86.6% OS rate, whereas only 72.7% of uninsured patients and 73.1% of Medicaid patients were alive at 5 years.”


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With that in mind, Dr Brunner said, patients and providers need to think about the cost of therapy, and the options for dealing with them, as they devise the treatment plan.

“We need to be sure that we are considering the ability of patients to actually obtain and have a steady supply of medication,” he said. “Medical insurance is a very complex system and it’s hard for most patients and providers to accurately assess what is needed…For patients who are uninsured or underinsured there often needs to be some creative thinking around getting patients access.”

The author of an editorial that accompanied the CML study, Michael J. Mauro, MD, leader of the Myeloproliferative Neoplasms Program at Memorial Sloan Kettering Cancer Center in New York, New York, agreed. Patients, he said, need to work with their provider and recognize that maintaining the necessary flow of medication won’t be easy.7

“I would say, expect a battle,” he said. “Patients and their physicians have to expect that there are barriers thrown down in oral therapy for cancer. That’s a general rule. Prior authorization requests are normal. Denials are normal. Having to work through copay issues is normal. Many need to seek philanthropy or support for co-pay. It’s just that it’s now all normal and not the exception.

“People have to really become familiarized with these things because they have become necessary.”

Dr Brunner said staff at his hospital understand the challenges, and assist patients in reviewing their insurance coverage.

“Often,” he said, “at the same time as we’re working with somebody about establishing a treatment plan, we’re also working with them to make sure that they’re on the best insurance program to cover their needs. And sometimes we have to try to switch patients to a different insurance plan.”

Patients, he said, should be open from the start about their ability to pay. They may be able to get help with copayments from a manufacturer’s financial assistance program, or through a philanthropic group such as HealthWell or Patient Services, Inc.

“I’d much rather know that you’re having trouble affording a medication or that you’re having trouble getting it sooner than later,” Dr Brunner said, “because if I don’t learn about it until several months have gone by, then we really haven’t been achieving an optimal treatment response.”

That’s especially true with CML, Dr Mauro said, where consistency of treatment is critical.

“The difference between taking your medicine regularly vs not taking it regularly means the difference between success and potential failure or resistance; a change in taking consistent medication can be triggered by a delay in access, a financial hardship, or many other things.

“I hear the story all the time about people who have to space their medication out in order to make longer use of it — only half a piece of bread today because they don’t have a whole piece of bread. That doesn’t work in the treatment of CML.”

References

  1. Perry AM, Brunner AM, Zou T, et al. Association between insurance status at diagnosis and overall survival in chronic myeloid leukemia: a population-based study. Cancer. 2017 May 2. doi: 10.1002/cncr.30639 [Epub ahead of print]
  2. Walker GV, Grant SR, Guadagnolo BA, et al. Disparities in stage at diagnosis, treatment, and survival in nonelderly adult patients with cancer according to insurance status. J Clin Oncol. 2014;32(28):3118-25. doi: 10.1200/JCO.2014.55.6258
  3. Kantarjian H. The arrival of generic imatinib into the U.S. market: an educational event. The ASCO Post website. http://www.ascopost.com/issues/may-25-2016/the-arrival-of-generic-imatinib-into-the-us-market-an-educational-event/. Published May 25, 2016. Accessed May 2017.
  4. Dusetzina SB, Winn AN, Abel GA, Huskamp HA, Keating NL. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol. 2014;32(4):306-11. doi: 10.1200/JCO.2013.52.9123
  5. Cancer stat facts: chronic myeloid leukemia (CML). National Cancer Institute website. https://seer.cancer.gov/statfacts/html/cmyl.html. Accessed May 2017.
  6. Huang X, Cortes J, Kantarjian H. Estimations of the increasing prevalence and plateau prevalence of chronic myeloid leukemia in the era of tyrosine kinase inhibitor therapy. Cancer. 2012;118(12):3123-7. doi: 10.1002/cncr.26679
  7. Mauro MJ. Running the marathon of chronic myeloid leukemia with no shoes (or without the right shoes)! Cancer. 2017 May 2. doi: 10.1002/cncr.30638 [Epub ahead of print]