Most blood cancer patients initially denied coverage for oral medications

Most patients with blood cancers who have been prescribed oral anticancer drugs initially face rejection by insurers before being ultimately approved, according to a poster at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting. This study was also published in Blood in

Oral cancer medications for blood cancer are becoming more common. In the leukemia space, for example, oral formulations held 45.9% share of the market, according to data from Modor Intelligence. Oral medications offer improved patient compliance, and they can improve survival for patients.

But costs to payers and patients remain a barrier to access, say researchers from the University of Pennsylvania and the University of Texas MD Anderson Cancer Center. Insurers, both in Medicare and commercially, have put into place utilization management, including prior authorization, that can affect patient access.

“This study found substantial access barriers to specialty oral anticancer medications for blood cancer, particularly among commercially insured patients,” researchers wrote. “Even after insurer approval, many patients never filled their prescription. This highlights the importance of addressing both payer-level restrictions and patient-level affordability challenges to ensure treatment access.”

Led by Jalpa A. Doshi, Ph.D., Leon Hess Professor of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, researchers wanted to examine approval and fill rates of specialty oral anticancer medication prescriptions for blood cancers for patients with Medicare and commercial insurance.

Using Symphony Health Solutions Integrated Dataverse, researchers assessed prescription and medical claims for 12,134 patients who had received a prescription for a new specialty oral anticancer medication. Of these patients, 61.0% were treated within the Medicare system, and 39.0% had commercial insurance. Researchers analyzed examined rejection reasons, eventual approval rates, and time to approval. Among approved prescriptions, they looked at the fill rates across different out-of-pocket cost levels.

Researchers found that insurers initially rejected 64.9% of specialty oral cancer medication claims in Medicare and 84.0% of claims commercially, mostly because of prior authorization or formulary restrictions. By 90 days, approval rates rose to 85.0% in Medicare and 62.9% in commercial plans.

They also found that many approved prescriptions were never filled. Ultimately, only 54.5% of Medicare patients and 45.5% of commercial patients both received insurer approval and filled their prescription. Patients generally did not pick up prescriptions when out-of-pocket costs were more than $175 per prescription. When out-of-pocket costs reached $2,000 per prescription, only 31.9% of Medicare patients and 26.9% of commercial patients filled their prescriptions.

The study was sponsored by Blood Cancer United, formerly the Leukemia & Lymphoma Society.