High costs make medications out-of-reach for oral cancer patients

The high out-of-pocket cost of oral cancer drugs may be leading Americans, including those with insurance, to forgo treatment, according to a study in the Journal of Clinical Oncology published in December.

Based on their findings, the researchers from the Perelman School of Medicine at the University of Pennsylvania raised questions about whether patients will be able to take advantage of new potentially life-saving or life-prolonging treatment options.

The study used a large database of prescription claims to track more than 38,000 people in the U.S. who received a new prescription for one of 38 oral cancer medications from 2014-15 to see whether patients filled the prescription after it was approved by their insurance, including Medicare, according to a news release.

The researchers found that 10 percent of patients failed to pick up their prescription when they were required to pay less than $10. However, of those charged $100-$500, about 32 percent of patients failed to pick up their prescription; 50 percent when out-of-pocket costs were more than $2,000.

“Patients in our study were facing a new cancer diagnosis or a change in their disease that required new treatment,” said lead author Jalpa A. Doshi, Ph.D., in a news release. “Imagine leaving your doctor’s office with a plan, ready to start treatment, only to find you can’t afford it. It adds more stress at what is already a stressful and scary time.”

Oral cancer is divided into two categories — those occurring in the oral cavity (your lips, the inside of your lips and cheeks, teeth, gums, the front two-thirds of your tongue and the floor and roof of your mouth) and those occurring in the oropharynx (middle region of the throat, including the tonsils and base of the tongue). Together, these cancers account for 2.9 percent of all cancers in the United States. The 5-year survival rate of those diagnosed with oral cancer is about 60 percent.

“Our results highlight the pressing need for all stakeholders — including manufacturers, pharmacy benefit managers, payers, and policymakers — to identify fiscally sustainable strategies to improve patient access to cancer medications,” the researchers wrote.

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This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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