250588 Comparison of availability and accessibility of oral oncology products between Medicare, commercial US, and UK National Health Service patient populations

Monday, October 31, 2011: 1:42 PM

Olubiyi Aworunse, MBBS MPH Candidate , School of Public Health, University of Texas Houston, Houston, TX
Lincy S. Lal, PharmD, PhD , Pharmacy Strategy and Analytics, Ingenix Consulting, Missouri City, TX
Pauline Vaillancourt Rosenau, PhD , Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX
Background: Newly approved oral agents for cancer have forced a paradigm shift in where cancer in managed and how cancer care in paid for and reimbursed within different healthcare systems. Before cancer was a disease managed in the inpatient and ambulatory care settings; however, the advent of these new agents have moved the care of cancer patient to the outpatient setting and have made chemotherapy a part of the pharmacy benefit of health insurance. Methods: We evaluated the availability of the newly approval oral targeted agents in the United States commercial and Medicare populations and compared to the United Kingdom National Health Service population. Approved indications and reimbursement indications (both on-label and off-label) were compared for the different study groups. Additionally pricing strategies were compared across the different populations in the outpatient setting. Results: Nine oral targeted agents have been approved for oncology patients, both in the United States and the European Union. Of these nine agents, six have only one approved indication, three have two approved indications. Three of these agents, sorafenib, sunitinib, and laptinib have significant off-label usage within the Medicare and Commercial US populations. Pricing strategies vary by type of health plan, with Medicare patients having to pay the highest out-of-pocket amounts of the three groups compared. Conclusions: While both the US Medicare and commercial health plans have increased availability of these agents, including reimbursement for off-label indications, out-of-pocket amounts are highest for the Medicare patients, a group with limited incomes.

Learning Areas:
Provision of health care to the public
Public health or related public policy

Learning Objectives:
1. Describe the on-label and off-label indications for new oral oncology products. 2. Differentiate between the approved indications and reimbursed indications for new oral oncology products in the US medicare, US commercial, and UK National Health Service patient populations. 3. Compare the pricing strategies between teh US medicare and US commercial populations.

Keywords: Access, Health Insurance

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Yes, off-label uses for which reimbursement is approved for in the US healthcare system.

Qualified on the content I am responsible for because: This research was part of my required learning experience at the UT School of Public Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.