Insurance barriers limit access to blood cancer drugs

A nationwide analysis led by researchers at the University of Pennsylvania’s Perelman School of Medicine finds that insurance rules can restrict access to specialty oral drugs for blood cancers, even when they are covered. The study followed more than 12,000 Medicare and commercially insured patients newly prescribed oral anticancer therapies in 2022, tracking whether prescriptions were rejected at first submission, approved, and filled within 90 days. At the initial pharmacy step, 64.9% of Medicare prescriptions and 84% of commercially insured prescriptions were rejected. Approval rose later to 85% (Medicare) and 62.9% (commercial). Common rejection reasons included prior authorization and lack of coverage. The report also noted lower fill rates after approval, tied to high out-of-pocket costs.