title: Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis.
abstract: OBJECTIVE
  Oral oncolytics are an increasingly important treatment option for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket (OOP) cost burden for patients. The purpose of this study was to evaluate patient OOP payments for oral oncolytic therapies in US managed care plans.
  
  
  METHODS
  Patients age ≥ 18 years who received one of 21 oral oncolytics were identified in 2009 US claims; the first oral therapy was the index therapy. OOP payments were calculated as the allowed amount (dollar amount a health plan allows for a therapy, including member liability) minus the paid amount (dollar amount paid by a health plan). Patient characteristics were provided, and per-claim OOP payments were evaluated for each of the 21 therapies in aggregate and stratified by payer type and index therapy.
  
  
  RESULTS
  A total of 6,094 patients who received at least one oral oncolytic therapy were identified. Mean age was 53 years; 54% were women; 77% had a commercial payer; prevalent cancer diagnoses included breast, colorectal, glioblastoma, and lung. Mean OOP payments were highest for dasatinib ($527; median, $36) and lowest for cyclophosphamide ($15; median, $10). Medicare Risk patients had higher mean OOP payments for most therapies compared with commercial, Medicaid, and self-insured patients.
  
  
  CONCLUSIONS
  Among 21 oral oncolytics, average OOP cost ranged from $15 to > $500. These results confirm previous findings showing OOP payments differing widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient OOP cost will be critical in informing choices.
authors.affiliation: Genentech, South San Francisco, CA; and IMS Health, Watertown, MA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Raborn
authors.forename: Elise M
authors.initials: EM
authors.lastname: Pelletier
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Smith
authors.forename: Carolina M
authors.initials: CM
authors.lastname: Reyes