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Out-of-Pocket Costs of Oral Hormonal Therapies High for Patients With Prostate Cancer

February 19, 2021


Eric Schwartz, MD, Michigan Medicine, Ann Arbor, discusses results from an analysis examining out-of-pocket costs for patients with prostate cancer prescribed abiraterone or enzalutamide.

These results were presented at the virtual 2021 ASCO Genitourinary Cancers Symposium.


Hi there. My name is Eric Schwartz. I'm a medical oncology fellow at the University of Michigan. Today I'm talking a little bit about my abstract that was presented at the ASCO GU meeting in 2021. This project is looking at financial burdens for patients with prostate cancer who were prescribed oral hormonal therapies, specifically abiraterone or enzalutamide.

A little bit of background on this study. We know that cancer care has gotten increasingly expensive. While there's been a whole host of new, novel treatments across cancer types, those treatments have significant financial costs. Oftentimes, patients bear a significant burden. A number of studies have shown that financial stress is very common among cancer patients at large. 

Specifically, the use of abiraterone, enzalutamide has continued to grow and expand in patients with prostate cancer, moving earlier in the disease process. The list prices remain extremely high for those, both retailing close to $10,000 a month before factoring in insurance, copays, and things like that.

While many patients have insurance that covers those costs, we haven't looked at how much of that burden patients are bearing. While there are different programs available to help offset the costs not covered by insurance such as grants from charitable cancer organizations or free drug programs from manufacturers, we know those don't capture everybody still. In other cancers, it's been shown that patients can be left out. 

For our study, we looked at patients prescribed abiraterone or enzalutamide between 2017 and 2019 at our cancer institution. We reviewed their charts both for clinical data and then we worked with some pharmacists in our cancer center who have looked through different financial data, insurance types, assistance mechanisms, things like that.

We identified 209 patients during that interval that had 1 of those 2 drugs filled at our specialty pharmacy or who received free drug from the manufacturer. We excluded patients who filled through an external pharmacy because of a lack of data about the costs and mechanisms of those costs for those patients.

What we found, primarily found that our patients either use Medicare Part D or commercial insurance, about two-thirds Medicare Part D and about a third commercial insurance. That was what we focused on. There were a small number with Medicaid and a small number with no insurance, but a little hard to make inferences in that small subset.

What we found is a pretty stark difference between costs for the abiraterone and enzalutamide in those 2 populations. In the Medicare Part D population, the average cost was $552 a month for the first out‑of‑pocket fill versus only $59 for those with commercial insurance. 

Within that group of Medicare Part D patients, 20% of them had a first out‑of‑pocket cost that was more than $1,000 for their first 30 days and then 7% of the people who we identified actually never filled their medicine and, specifically through the notes, was cited as the cost of the medication as a reason that they were unable to fill.

We then looked at what was the range and who was being affected. We found that financial assistance programs, we know they exist. They were able to offset costs for about 35% of Medicare Part D patients, either those patient assistance programs or financial grants. 

Those patients, the cost was lowered down to either $0 or very close to $0 and affordable. Some other patients who had supplemental insurances and things presumably could lower their costs as well, but a very wide range with still a very large number of patients experiencing significant out‑of‑pocket costs in order to afford their abiraterone or enzalutamide.

For this study, we primarily looked at that data and how that translates into the real world of what patients can afford. Moving forward, we hope to delve a little bit deeper, looking at data regarding adherence to medications and how costs and type of insurance might impact ability to stay on treatment as well as time on treatment and then some other clinical outcomes.

We're also working on some surveys to try and assess patient experiences both in terms of applying for these complex programs, if they feel that they've experienced delays or other issues with their treatment, and if they've experienced financial stress related to obtaining these medications.

That is what we showed, what we presented at GU ASCO this year. We're looking forward to continuing this data and continuing to understand these financial burdens in our patient population.

Schwartz EB, Jeong A, Roman A. Evaluating financial burdens of oral hormonal therapies for patients with prostate cancer. Presented at: the virtual 2021 ASCO Genitourinary Cancers Symposium; February 11-13, 2021. Abstract 70.

Dr Schwartz reports no relevant financial relationships.

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