Although easier to administer than in-office infusions, oral drugs pose many challenges, he said. More of the financial burden is being shifted to patients, as payers try to figure out how to cover the higher prices of these drugs. Responsibility for compliance also shifts to patients, as they are expected to take their medications at home and call their oncologists if they are experiencing side effects. And practices must have staff to take those phone calls and manage those side effects.
One of the strategies is having an in-office pharmacy, which helps community oncologists to make sure that their patients are receiving the prescribed oral drugs, and to find assistance if a patient can't afford them. A challenge, however, is that some state laws bar pharmacies in medical practices.
Access to Clinical Trials
Another issue being addressed first by the states is making sure payers cover routine patient care for patients in clinical trials. Typically, trials pay for the cost of a patient's medications, but they do not pick up other expenses that are routine to cancer care. Without such laws or regulations, some payers refuse to cover supportive care, even though they save substantially on medication costs for patients in trials. “I think misconceptions about clinical trials are prevalent both with payers and with federal policy makers,” Ms. Foster said.
Federal Action Expected
Although the speakers agreed that health reform was stalled in Washington, the consensus was that something would pass. “The issues being discussed before [Republican Sen. Scott Brown's] election in Massachusetts are not going away. … The prospects for health reform in some small fashion are good; in large fashion, they are going to be very, very difficult,” Ms. Foster said. Moreover, reforms will come about through regulatory changes regardless of Congressional action, according to Mr. Okon.
Disclosures: The journal Community Oncology and this news organization are owned by Elsevier.
With oral cancer drugs, both the high financial burden and the responsibility for compliance shift to patients.
Source DR. FAVARO