Helping patients navigate rising costs for prostate cancer treatment

How drug costs can increase financial burden on patients even with insurance coverage

Cancer is one of the most expensive medical conditions to treat in the US and often leads to financial toxicity that can impact care.

In a study of 281 patients, 54% had some degree of financial hardship due to cancer.¹

Of the men with the highest financial toxicity, 89% had illness-related money troubles.¹

These men were significantly more likely to decrease spending on basic goods such as food and clothing and more commonly raided their savings to pay for treatment.¹

Cost-of-living up 4.7% overall since 2020 with both food and energy increasing the most at 5.4% and 8.9% respectively. This causes patients to really think about how they can ensure they get the care they need but also afford just basic living needs.²

24% Out-of pocket cost burden for patients with cancer²

One in five prostate cancer patients reported a need to reduce spending or make sacrifices to afford treatment.^3,4

Approximately 25% of the cancer patients started experiencing financial difficulty within the first three months of treatment⁵

Patients also reported lower social functioning and quality of life at six months than the patients who didn’t start struggling financially until later in their treatment trajectory.⁵

How drug prices can affect a patient’s out-of-pocket cost

A drug’s price can greatly affect the out-of-pocket cost to a patient therefore it is important to consult with a patient prior to treatment.

Patient Cost Burden by Coverage Type*

If treatment cost is high, perhaps see if a similar, more responsibly priced product is available with similar efficacy and discuss with the provider if that alternative product is available and right for that patient.

Does your office consider cost burden as a side effect of treatment?

Helping to cover co-pay or coinsurance cost

While there are many charitable organizations that can help with covering copay or coinsurance costs, many have strict income or geography requirements.
Even if a patient qualifies, funding is always limited and access to these organizations can come and go very quickly.

If a patient gets funding, that funding should be used in the most efficient way to ensure as many patients as possible are covered.

Using a product that is lower in price with similar efficacy can help ensure that those charitable funds stretch as far as possible.

Ways to help patients discuss financial toxicity with your patients:

Always discuss coverage and cost prior to a patient starting a new therapy or drug
Follow up with questions like: “Do you have any concerns about paying for your treatment?” “Tell me what you understand about the out-of-pocket costs for your treatment.”
Refer patients to assistant programs like RxAssist or Medicare Pharmaceutical Assistance Program if they need support
If you see that a patient’s out-of-pocket cost has increased, follow up with their physician to see if a different product was used. If so, discuss as a care team possibly going back to the original product or if other more affordable options are available

More formal clinical financial assessments have been proposed as part of the American Society of Clinical Oncology’s (ASCO’s) Financial Toxicity Grading Criteria and discussed in ASCO’s booklet Managing the Costs of Cancer Care: Practical Guidance for Patients and Families.

How one product –

continues to offer consistent low pricing, even in a world where most products are rising in price

ELIGARD has NOT had a WAC increase in over 8 years⁹

ELIGARD has consistently had one of the lowest WACs in the LHRH market, ensuring that cost burden to the patient is kept as low as possible.

Tolmar is meeting the needs of patients and providers

Tolmar is committed to keeping ELIGARD responsibly priced to ensure access across healthcare systems, providers, and most importantly – patients

Patient Access Support

Practice Support

Clinical Support

Low OOP Expense

To learn more about ELIGARD’s proven efficacy and flexible dosing visit Eligardhcp.com

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IMPORTANT SAFETY INFORMATION

ELIGARD^®, (leuprolide acetate) for injectable suspension, is a gonadotropin releasing hormone (GnRH) agonist indicated for the treatment of advanced prostate cancer.

ELIGARD is contraindicated in patients with hypersensitivity to GnRH, GnRH agonists, or any of the components of ELIGARD. Anaphylactic reactions to synthetic GnRH or GnRH agonists have been reported in the literature. Transient increase in serum levels of testosterone during treatment may result in worsening of symptoms or onset of new signs and symptoms during the first few weeks of treatment, including bone pain, neuropathy, hematuria, bladder outlet obstruction, ureteral obstruction, or spinal cord compression. Monitor patients at risk closely and manage as appropriate.

Hyperglycemia and an increased risk of developing diabetes have been reported in men receiving GnRH agonists. Monitor blood glucose level and manage according to current clinical practice. Increased risk of myocardial infarction, sudden cardiac death and stroke has also been reported with use of GnRH agonists in men. Monitor for cardiovascular disease and manage according to current clinical practice. Androgen deprivation therapy may prolong the QT/QTc interval. Consider risks and benefits. May cause fetal harm. Convulsions have been observed in patients taking leuprolide acetate with or without a history of predisposing factors. Manage convulsions according to current clinical practice.

ELIGARD may impair fertility in males of reproductive potential.

The most common injection site adverse events are transient burning and stinging, pain, bruising, and erythema. The most common systemic adverse events include mild to severe hot flashes/sweats, malaise and fatigue, weakness, myalgia, dizziness, clamminess, testicular atrophy, and gynecomastia. As with other GnRH agonists, other adverse reactions,
including decreased bone density and rare cases of pituitary apoplexy have been reported. Please visit EligardHCP.com for full Prescribing and Safety Information

References:

1. Persaud N. Renal & Urology News, Urology, Prostate Cancer. https://www.renalandurologynews.com/home/news/urology/prostate-cancer/financial-toxicity-common-stressful-in-metastatic-prostate-cancer/ (visited August 20, 2023).

2. Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Consumer prices up 4.7 percent since February 2020 at https://www.bls.gov/opub/ted/2021/consumer-prices-up-4-7-percent-since-february-2020.htm (visited July 10, 2023).

3. Conti RM, et al. Reform Medicare Part B to improve affordability and equity. https://www.healthaffairs.org/do/10.1377/forefront.20210622.349716/full/. Accessed April 24, 2023.

4. Ginsburg PB, Lieberman SM. Medicare payment for physician-administered (Part B) drugs: the interim final rule and a better way forward. https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2021/02/10/medicare-payment-for-physician-administered-part-b-drugs/. Accessed April 21, 2023.

5. Even Insured Patients With Advanced Cancer Experience Financial Toxicity March 16, 2022 by Elisa Becze BA, ELS, Editor

6. Centers for Medicare & Medicaid Services. 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts (fact sheet). September 27, 2022. https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly.

7. Kaiser Family Foundation. An overview of the Medicare Part D prescription drug benefit. https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-prescription-drug-benefit/. Accessed April 13, 2023.

8. Kaiser Family Foundation. Employer Health Benefits: 2022 Annual Survey. San Francisco, CA: Kaiser Family Foundation; 2022.

9. Data on file, Tolmar, Inc.