Webinar Highlights Ways Cancer Patients Are Impacted by Insurance

Leaders in the oncology space discussed ways to ensure oncology care access at the 2024 Pharmacy Benefit Management Institute webinar, Managing Access to Patient Care (MAP), held this morning.

Jon Hamrick, a founding partner at Curatio Scientia, moderated the panel of four industry representatives.

There was a heavy focus on the importance of the patient’s journey and the latest trends in the oncology market. “In a perfect world, the payer component shouldn't have an influence on their clinical experience, but we know it does. It's our job as an industry to avoid that,” Benito Fernandez, Chief Commercial Officer at oncology pharmacy Onco360 said. “We need to get medication in hand as quickly as possible.”

Continued pressures from copay accumulators, maximizers and alternative funding programs prevent access to prescriptions, Lurid said. With accumlator programs, any copay assistance would not count toward the family’s deductible. A maximizer sets the cost-sharing to equal the manufacturer's copay assistance.

These programs are growing According to a 2022 report from clinical research company IQVIA Institute for Human Data Science, these types of programs have grown from 14% in 2019 to 33% in 2022.

Panelists also addressed the Inflation Reduction Act, which was signed into law by President Joseph Biden in August 2022. In January 2024, the Extra Help program was launched, which will cut costs further for eligible low-income Medicare patients. This, panelists said, helps cancer patients because of the high costs of some oncology drugs.

"Affordability is getting better for patients,” Ela Lourido, MS, VP and General Manager, Specialty Pharmacy Solutions at McKesson said.“However, it was a little bit turbulent as it relates to foundation support for patients this year. A lot of them had kept their grants at a lower rate. So many of us in the industry had to really go out and get multiple grants for patients.”

Other panelists addressed the need for better treatment adherence. One of the suggestions on how to increase this was artificial intelligence. Rich Gourash, RPh, MBA VP of Oncology at BioPlus, suggested that AI be used to monitor missed doses and monitor symptoms.

Frank Scimeca, Pharm.D., MBA, BCOP, VP, Pharmacy Services at Florida Cancer Specialists & Research Institute predicts that AI will become a large trend in patient care management in the next 18 to 36 months.