Navigating Insurance Hurdles for Oral AML Therapy Access

While the all-oral regimen of decitabine/cedazuridine (DEC-C; Inqovi) plus venetoclax (Venclexta) for patients with acute myeloid leukemia (AML) maximizes patient convenience, clinicians who use oral specialty oncology medications can face distinct insurance hurdles compared with medical-benefit intravenous therapies. CancerNetwork® spoke with Michael R. Savona, MD, professor of internal medicine and cancer biology and director of the Hematologic Malignancies Research and Early Therapy Program at Vanderbilt University Medical Center; and Courtney D. DiNardo, MD, MSCE, professor in the Department of Leukemia and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, about how they and their teams navigate administrative and financial logistics to get patients timely access to treatment.

Transcript:

CancerNetwork: While an all-oral regimen maximizes patient convenience, oral specialty oncology medications can have distinct insurance hurdles compared with medical-benefit IV therapies. How are you and your teams navigating the administrative and financial logistics to ensure patients get timely access to this treatment?

Savona: In reality, it is sometimes a little tricky. Often, about 75% of the time, I do not have any issue getting the medicine for the patient, and I think that will continue to get better over time. I would not say insurance hurdles; these are hurdles with the insurance company. There is no reason medically appropriate therapy should not be given. The reality is that oral drugs are covered under a different insurance package than drugs given IV in the clinic. This will, in some instances, limit availability for some patients. All we can do is continue to publish [data], be available to answer questions, and manage peer-to-peer discussions with insurers to make that easier.

DiNardo: I agree, and I would say a simple fix, as we have been doing, is to just start the first cycle with the IV form, and then once insurance comes through, if there is a challenge for that patient, you can get that approval and transition with cycle 2 and beyond. This is an FDA-approved indication now, so there is no reason it should be an issue. It is just whether certain copay assistance programs or paperwork end up taking longer than they should, and you do not want to wait longer than you need to before starting a patient with a new leukemia diagnosis.