This article provides a sweeping historical and modern day perspective on the care delivery ecosystem beyond the four walls of a hospital. While site of care (hospital, community, home, remote, etc.), and its appropriateness / value remains a hot topic of debate, there is no questioning that ultimately the best interests of the patient should govern where care is received / delivered. For oncology/hematology patients, safe, convenient and high quality / low cost care is best received in community settings, like here at Florida Cancer Specialists & Research Institute.
Impact of Co-pay Assistance on Patient, Clinical, and Economic Outcomes
Nathan Walcker's Thoughts
Here we see a review of literature assessing the impact of patient assistance programs on outcomes broadly in cancer care. While indirect links may be drawn between the prevalence of financial toxicities and outcomes, adherence, etc., additional research studies are needed to more clearly demonstrate the tangible impact of these programs to support future investments from stakeholders.
Patient assistance programs (eg, co-pay assistance) may reduce patients’ out-of-pocket costs for prescription medicines, providing financial assistance to access medicines for reduced or no cost. A literature review to identify peer-reviewed articles on studies evaluating the impact of co-pay assistance on clinical, patient, and economic outcomes was conducted.
A literature review was conducted by searching Embase and MEDLINE.
The population of interest was patients who had received co-pay assistance; the intervention was co-pay assistance; comparator was no co-pay assistance; and outcomes were treatment adherence, compliance, discontinuation, interruption, barriers to adherence, and specific therapeutic outcomes. Articles from the United States published between January 2015 and June 2021 were included.
A total of 1249 initial articles were identified, of which 19 published articles representing 12 studies were included. Most studies were retrospective claims analyses (n = 10); there was also 1 randomized controlled trial and 1 prospective and observational study. One article assessed the association between co-pay assistance and patient-reported outcomes, 7 explored the relationship between co-pay assistance and clinical outcomes, and 6 assessed the impact of policy/program changes on co-pay assistance. Co-pay assistance was associated with improved treatment persistence/adherence across various diseases, with limited indirect evidence of this translating into clinical outcomes improvements. Lack of long-term outcomes and uncertainty around program sustainment from co-pay assistance programs are limitations.
Limited evidence suggests a potential link between co-pay assistance and clinical outcomes; future research addressing study design challenges in measuring the effects of co-pay assistance is needed.
Author AffiliationsGenentech, Inc (KDP, WBW), South San Francisco, CA; Department of Population Health Sciences, Duke University School of Medicine (LLZ), Durham, NC; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System (LLZ), Durham, NC.
Compliance of National Cancer Institute–Designated Cancer Centers With January 2021 Price Transparency Requirements
While price transparency across sites of care on its face is a step in the right direction, datapoints when viewed discretely are less informative when it comes to the actual costs associated with cancer care. Additional work, analysis and research is much needed across the stakeholder continuum to fully understand the costs associated with the treatment of cancer, and to further achieve the transparency goals set forth by CMS in 2019 with this initiative.
STAT News published the below Op Ed from COA that does that highlights the dysfunction of the 340B system and how Hospital Systems and PBMs are profiting Billions of dollars a year off of a program that was intended to help underserved patients. Is a great “high level” review to help understand the overall impact on the US medical system and the importance of health care reform in this area.
Analysis of 61 NCI-designated cancers demonstrate parenteral cancer drug price markups across all centers ranging between 188.4% to 633.6%. Only 27 centers publicly disclose payer-specific prices for cancer therapies as required by federal regulation. Authors recommend public policies to discourage excessive hospital price markups on patenteral chemotherapeutics to reduce financial burden on cancer treatment for patients.
Thought-provoking oped highlighting the underbelly of buzzwords in healthcare today. The shift from volume to value that we’ve seen unfold over the past 3-5 years has moved front and center in many conversations, yet remains elusive insofar as its definition and implementation. This article rightly calls out that value is ultimately in the eye of the beholder, and yet there’s no disputing that doing what’s right for the patient trumps all.