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(IV) infused treatment. Oncolytic medications that can be adminis-
tered orally are a relatively new addition to cancer treatment and
provide patients with the benefits of ease of use and convenience.1 Uti-
lization of oral oncolytics is expected to increase.2 Recent reports have
suggested they account for approximately 25% of the current oncology
Because of costs associated with these newer oral oncolytic agents,
pharmacy benefit plans may implement cost-containment mechanisms
such as increased patient cost sharing through placement in higher co-
payment tiers. The degree to which increased cost sharing influences
access to and utilization of oral oncolytics may be an important factor
affecting patient adherence to prescribed cancer therapy.
Traditional adherence studies of oncology medication track patient
utilization longitudinally by assessing refill rate, self-reported compli-
ance with prescribed therapies, continuous dose observations, pill count-
ing, and administrative claims analysis.1,4 Studies of nonadherence have
found that barriers to appropriate care include cost-sharing requirements,
agent toxicity, patient- and disease-related factors, social issues, and fi-
The purpose of our study was to assess abandonment of newly initiat-
ed oral oncolytics. Specifically, we were interested in examining patients
who had been prescribed oral oncolytic therapy, submitted prescriptions
for their first oral oncology medications to pharmacies, and then reversed
claims after adjudication (ie, initial approval of claim). If patients did
not follow up with a subsequent oncolytic agent, we noted their reversed
claim as an abandoned prescription.
Our objective was to calculate reversal and abandonment rates of
newly initiated oral oncolytic medications using an approach similar to
those found in the literature.5-7 Building on previous research, we inves-
tigated the degree to which abandonment is affected by patient and plan
characteristics, specifically cost-sharing requirements, patient income,
concurrent prescription activity, and insurance type.
atients diagnosed with cancer require timely access to appro-
priate treatments to achieve optimal outcomes. Until recently,
drug therapy for patients with cancer consisted of intravenous
We acquired administrative
claims data from the Wolters Klu-
Patient and Plan Characteristics Affecting Abandonment of
Oral Oncolytic Prescriptions
Sonya Blesser Streeter, MPP, MPH; Lee Schwartzberg, MD; Nadia Husain, ScM;
and Michael Johnsrud, PhD
In this issue
Take-Away Points / SP39
Full text and PDF
Objective: To calculate the abandonment rate of
oral oncolytic medications and identify factors
that may affect likelihood of abandonment.
Study Design: Cross-sectional cohort study using
administrative claims data.
Methods: We analyzed a nationally representa-
tive pharmacy claims database and identified
10,508 patients with Medicare and commercial
insurance for whom oral oncolytic therapy was
initiated between 2007 and 2009. We calculated
the abandonment rate for the initial claim, in
which abandonment was defined as reversal
of an adjudicated pharmacy claim without a
subsequent paid claim for any oncolytic (oral or
intravenous) within the ensuing 90 days. We as-
sessed likelihood of abandonment using bivari-
ate and multivariate logistic regression analyses
including patient demographics, plan type, drug
type, cost sharing, and concurrent prescription
Results: The abandonment rate of newly initiated
oral oncolytics was 10.0%. Unadjusted bivariate
analyses found that high cost sharing, increased
prescription activity, lower income, and Medicare
coverage were associated with a higher aban-
donment rate (P <.05). In the logistic regression
model, claims with cost sharing greater than
$500 were 4 times more likely to be abandoned
than claims with cost sharing of $100 or less
(odds ratio [OR], 4.46; P <.001). Patients with 5
or more prescription claims processed within in
the previous month had 50% higher likelihood
of abandonment than patients with no other
prescription activity (OR, 1.50; P <.001).
Conclusion: Abandonment of newly prescribed
oral oncolytic therapy is not uncommon, and the
likelihood increases for patients enrolled in plans
with pharmacy benefit designs that require high
cost sharing. Increased concurrent prescription
activity was also associated with a higher aban-
donment rate. These factors should be taken into
account when considering likely adherence to
(Am J Manag Care. 2011;17(5 Spec No.):SP38-SP44)
For author information and disclosures,
see end of text.
Copyright © 2011 by American Society of Clinical Oncology
and Managed Care & Healthcare Communications, LLC.
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? CLINICAL ?
We thank Harry Barnes, MD, for his review of the manuscript. This re-
search was funded by the Community Oncology Alliance in partnership with
Celgene, Genentech, Millenium Pharmaceuticals, Novartis Pharmaceuticals,
Authors’ Disclosures of Potential Conflicts of Interest: Although all
authors completed the disclosure declaration, the following author(s) in-
dicated a financial or other interest that is relevant to the subject mat-
ter under consideration in this article. Certain relationships marked with
a “U” are those for which no compensation was received; those relation-
ships marked with a “C” were compensated. For a detailed description of
the disclosure categories, or for more information about ASCO’s conflict
of interest policy, please refer to the Author Disclosure Declaration and
the Disclosures of Potential Conflicts of Interest section in Information for
Employment or Leadership Position: Sonya Blesser Streeter, Avalere
Health (C); Nadia Husain, Avalere Health (C); Michael Johnsrud, Avalere
Health (C). Consultant or Advisory Role: None. Stock Ownership: None.
Honoraria: None. Research Funding: None. Expert Testimony: None. Oth-
er Remuneration: None.
Conception and design: Sonya Blesser Streeter, Lee Schwartzberg, Mi-
chael Johnsrud. Administrative support: Sonya Blesser Streeter, Michael
Johnsrud. Provision of study material or patients: Sonya Blesser Streeter,
Michael Johnsrud. Collection and assembly of data: Sonya Blesser Streeter,
Michael Johnsrud. Data analysis and interpretation: Sonya Blesser Streeter,
Lee Schwartzberg, Nadia Husain, Michael Johnsrud. Manuscript writing:
Sonya Blesser Streeter, Lee Schwartzberg, Nadia Husain, Michael Johnsrud.
Final approval of manuscript: Sonya Blesser Streeter, Lee Schwartzberg,
Nadia Husain, Michael Johnsrud.
Address Correspondence to: Michael Johnsrud, PhD, Senior Vice
President, Avalere Health, Health Economics and Outcomes Services,
1350 Connecticut Ave NW, Washington, DC 20036; e-mail: mjohnsrd@
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