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Cancer Agents Taken Orally Pose Adherence Problems Despite Ease of Administration

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Cancer Agents Taken Orally Pose Adherence Problems Despite Ease of Administration
The regimens can be complex. PBMs use education, outreach, split fills, and other techniques to help with adherence.
Thomas Reinke
Oral chemotherapy drugs have transformed cancer care. Agents such as imatinib (Gleevec) opened the door to long-term remission in chronic myelogenous leukemia (CML). Since then, other oral therapies have improved disease progression and survival in many different cancers. Oral chemotherapy drugs can be used as first- and second-line treatments and as chronic therapy.

Complete adherence to oral chemotherapy may seem like a slam dunk for patients who have total control over these medications. But the increased use of oral oncolytics in complex regimens, plus the multiple personal variables that influence adherence, make adherence a challenge for clinicians and specialty pharmacists.

Health plans and PBMs face additional pressures that force them to continue to chip away on improving adherence for oral oncolytics. Retail pharmacies that dispense these drugs are touting their adherence programs, and the Medicare Part D star ratings program includes measures related to adherence.

Increased utilization
“The use of oral agents is increasing about 20% per year, which is faster than growth of the class as a whole,” says David Lassen, PharmD, chief clinical officer at Prime Therapeutics.

Mary Dorholt, PharmD, vice president and clinical practice lead at Accredo, an Express Scripts subsidiary and specialty pharmacy, says that “the incidence of cancer is growing because of the aging population and earlier detection, which increases utilization. We are also seeing greater complexity in therapy regimens and long-term use, which affect adherence.”

Oral agents are a significant factor in oncology’s rising costs, Dorholt notes: “Last year, we saw a 24% increase in the trend for oncology, compared with a 14% increase for specialty overall.” Oral therapy includes at least two drugs that cost more than $100,000, the leukemia agents ponatinib (Iclusig) and bosutinib (Bosulif).