Oral oncology drugs often go to waste

August 10, 2023

Image by Dall-E

Oral cancer drugs are more convenient and cost less to administer than intravenous infusions, but they can cost more than $150,000 a year. When an oral cancer therapy dose is changed because of adverse effects, expensive pills must be discarded unless pills can be split. Many oncology medications cannot be divided either because they are not scored or because disrupting the pill could change pharmacologic activity.

Researchers looked at published research studies of 22 of the most expensive oral oncology drugs (mostly approved since 2020) and found that on average dose reduction led to disposal of about $4300 of medications. Much of this waste could be eliminated if pharmaceutical manufacturers scored higher dose pills where possible. Alternatively, the authors suggest implementing a benefit design that allows for “split-fill” with 15-day fills with prorated cost sharing for the first three months of treatment.

While the average cost of drug wastage seems high, this remains under 2% of the cost of these oral cancer drugs.

Implications for employers:

-        Split fill programs can decrease waste of expensive medicines where drug choice or dose is often changed shortly after initial prescription. Inquire with your PBM on rebate impact

-        Pharmaceutical companies could decrease waste by producing pills that can be split in many instances, although this is not in their financial interest.

-        Employers should evaluate member affordability of these oral oncology treatments. Some patients face a larger cost sharing for their oral cancer drugs than they would if they were taking the intravenous formulation. Employers should not assume all oral medications are less costly.  

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Coming Friday: Obesity drug prevents cardiovascular events in nondiabetics

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