Why Do Some Cancer Prescriptions Encounter Delays?

Daniel O'Neil, MD, MPH


June 01, 2019

Hello, I'm Daniel O'Neil, a clinical fellow in medical oncology at New York Presbyterian Hospital and the Columbia University Irving Medical Center in New York City. I'm going to talk about our work looking at delays in the receipt of oral anti-cancer drugs.

These drugs are an increasingly important part of how we treat cancer patients, particularly patients with advanced cancers. However, they can be difficult and complex to prescribe. A new prescription usually requires coordination with specialty mail-order pharmacies, with insurers, and sometimes with financial aid agencies. Often the responsibility for coordinating these new prescriptions falls to clinical support staff and they can spend a significant amount of time on that work.

So, we decided to follow patients receiving new prescriptions for oral anti-cancer drugs in our medical oncology clinics. Over the course of 11 months, we kept track of all new prescriptions and looked at the date of prescription, the date the drug was actually delivered to patients, and all of the interactions with insurers, financial assistance groups and pharmacies in between.

What we found was that the median time to receive a drug was 8 days; nearly half of the drugs were delivered in 7 days or less. Unfortunately, 20 percent still took 14 days or longer to be obtained.

Several things were likely to impact the time to drug receipt. The biggest impact came from the need to pursue financial assistance. Other things that made a difference were whether the drug was being used off label; the daily cost of the drug; and whether the drug had been approved by the FDA less than 2 years before the prescription date.

Ideally, policy changes could be instituted to cut down on some of the complexity that goes into obtaining oral cancer drugs. And, given the impact of the need to pursue financial assistance on the time to receiving a drug, any efforts to keep drug costs down would also be beneficial.

Thank you very much for joining me from ASCO 2019 in Chicago.

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