Recent studies have indicated that about 1 in 5 people with CML have problems with adherence, i.e. taking their medication as directed by their doctor (Okumura and colleagues. Pharm Pract 2015;13:559; Trivedi and colleagues. J Manag Care Spec Pharm 2014;20:1006-1015). There are many reasons why people with life-threatening medical conditions don’t take their medications. They may have problems with side effects. They want to give themselves a “drug holiday”. Or they may simply forget.
But one reason that hasn’t been adequately explored is drug costs. What proportion of people stop taking their medication because they can no longer afford it? Or feel that whatever effectiveness they are receiving isn’t worth the out-of-pocket costs?
A U.S. study at a cancer centre in North Carolina looked at the impact that medication costs had on the treatment plan (Dusetzina and colleagues. J Clin Oncol 2014;32:306-311). Everyone in the study had insurance coverage; the average co-pay was $108 per month but had a wide range (from $0 up to over $4,000 per month). Remarkably, during the period of the study, from 2002 to 2011, the average monthly cost of Gleevec almost doubled.
Overall, 17% of people with higher co-payments stopped treatment within the first six months, and they were about 40% more likely to skip doses or take drug holidays, which may have indicated that they were trying to stretch their dollars.
The researchers also found that about 1 in 3 people diagnosed with CML did not start treatment within 6 months of being diagnosed. Drug costs also had an impact on when a person started treatment. For recipients of Medicare subsidies, the median time to starting treatment was 58 days. If the person wasn’t eligible for subsidies, the median time to starting treatment was 108 days. The study authors suggested that treatment may have been delayed among people without subsidies because they were trying to find ways to pay for their treatment.
The amount of drug reimbursement differs according to the country you live in. Out-of-pocket costs will also vary according to your insurance plan, and whether you can obtain co-payment relief from the drug manufacturers or local government. People who are having difficulty paying for their medication should call the patient support program associated with their medication – they can often help reduce your costs. For insurers, allowing high co-pays is short-sighted. The annual costs associated with treatment failure are estimated to be at least 10% higher than they would be if an individual is able to remain successfully on treatment (Knopf and colleagues. Clin Lymphoma Myeloma Leuk 2015;15:e163-171).