Insurance Barriers to High-Cost Anti-Infective Medications Post Allogeneic Hematopoietic Cell Transplant

Area of Science:

• Hematology
• Oncology
• Pharmacoeconomics

Background:

• Allogeneic hematopoietic cell transplantation (HCT) is a crucial treatment for hematologic malignancies.
• Prophylactic anti-infective medications are vital post-HCT but face insurance barriers, limiting patient access.
• These barriers include prior authorizations, denials, and high out-of-pocket costs, potentially affecting transplant outcomes.

Purpose of the Study:

• To assess the prevalence and severity of insurance barriers for high-cost prophylactic anti-infectives in allo-HCT recipients.
• To identify patient populations and transplant characteristics associated with these insurance challenges.
• To quantify the impact of these barriers on medication access and financial toxicity.

Main Methods:

• Retrospective analysis of medical and pharmacy records for allo-HCT recipients receiving mold-active azoles or letermovir (LTV).
• Evaluation of insurance type, ancestry/ethnicity, and stem cell source for patients experiencing insurance barriers.
• Categorization of barriers into Minimal to None, Moderate, and Extensive based on access and cost implications.

Main Results:

• Extensive insurance barriers affected 17% of patients on azoles and 33% on LTV, with significant out-of-pocket costs and need for financial assistance.
• Approximately 50% of the cohort required financial resources for essential medications, regardless of insurance type or transplant characteristics.
• Pharmacist intervention was crucial in overcoming barriers, with extensive barriers requiring over 60 minutes of coordination time per patient.

Conclusions:

• Insurance barriers pose a substantial challenge to accessing critical anti-infective medications in allo-HCT.
• Financial toxicity is prevalent, necessitating universal assessment for all patients undergoing HCT, irrespective of insurance or transplant type.
• Pharmacists play a key role in mitigating these financial and access-related issues for high-cost transplant medications.