Multiple Myeloma: Addressing Financial Barriers to Bispecifics


Key opinion leaders in multiple myeloma management address barriers inherent in the selection and use of bispecifics.


Cesar Rodriguez, MD: In terms of the financial component of this, if we were to start a patient with the step-ups in the hospital, we get the approval, the hospital is going to absorb the costs of the teclistamab, tocilizumab, and all of the agents that are required during the hospital stay. We don’t need to worry about how much of a financial burden that will be for the patient because it’s a package that the insurance will pay the hospital. If you were to model that for an outpatient and you only admit if there’s a complication, is there any difference or do you have any model that shows a potential difference in terms of the burden or implications financially for either the patient or the clinic? Have you started all outpatients from the beginning? Those patients are going
daily to check labs and infusions to make sure they’re doing okay, right?

Kirollos S. Hanna, PharmD, BCPS, BCOP: Yes, there is some burden on the patient. We talk to the insurance providers about what they will cover, including the hotel stay. We also have Hope Lodges and other types of facilities that have been welcoming to our cancer patients when they need that type of service. However, it is a daily clinic visit and there’s a laboratory drawn every day so there’s usually a co-pay associated with that. We haven’t yet done a complete analysis from a patient perspective. We’ve shown that it reduces the cost of care. From the clinic perspective, our cost of doing the work in the clinic is less than the cost of an extended stay in the hospital. From a payer perspective, as we start pushing and saying, “Look, we’re going to push this to the clinic, but these patients may need help in other areas. What can we negotiate to make that work?” On the CAR T side, it tends to be more of a case rate basis because it is all up-front money. Do we get to the point where we do something similar with teclistamab and plan it out over a period of time?
The vast majority of these patients are Medicare patients and there are no prior authorizations with Medicare. For Medicare, patients get treatment, then just hope that they will be reimbursed. We’ve only seen 1 problem so far, which is because we coded the disease wrong. We went back and corrected the coding and the Medicare then went through. Medicare is not going to help with the hotel costs. Looking at what the whole big picture is for patients, it’s worth it to see if we’re creating financial toxicity and an extra burden on the patients. We’d have to compare the copay and the out-of-pocket cost that patients are paying for the hospital stay, as well.

Cesar Rodriguez, MD: It’s like there’s always going to be some positives and some negatives to this. Currently, teclistamab goes through medical benefits because it’s an infusion. [Tocilizumab] also would go through medical benefits. Medicare is easy, the problem is the reimbursement. How long it will take to get reimbursed is what’s going to kill the ability to give these agents in community settings and small practices that don’t have a financial cushion to wait to be reimbursed. These are not cheap drugs. The goal of trying to give this treatment in an outpatient setting is something that we need to keep looking into. Insurance is going to pay for the therapy and labs. Patients
might have a co-pay if they need to be admitted. We also need to find resources for those who don’t live within 30 minutes of the facility or who don’t have transportation. How we can try to mitigate, [with] either a hospitality house or transportation, something to help offset that financial burden. Everybody wants to stay out of the hospital to avoid hearing the beeping sounds and getting bothered at random hours. Patients don’t rest
well in the hospital setting. It’s always better to stay at home. Patients get better rest at home, a quiet hotel, or hospitality house. That raises a great point, Scott [A. Soefje, PharmD]. We really need to think about not only the cost of what insurance is going to pay for, but all these ancillary costs like hotel, transportation. If we’re going to do outpatient care, how can we try to mitigate the financial burden.

Transcript edited for clarity.

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