Beyond Clinical Efficacy: How Cost, Access, and Operational Challenges Influence RRMM Treatment Decisions

In 'Beyond Clinical Efficacy: How Cost, Access, and Operational Challenges Influence RRMM Treatment Decisions,' our panel of experts delve into the following critical questions:

1. How are cost and access considerations influencing treatment selection at first relapse? Are patients being steered toward certain therapies for non-clinical reasons?
2. From a pharmacy or operational standpoint, what are the most significant logistical challenges associated with bispecific therapy, and how are institutions addressing them?
3. From a pharmacy or managed care perspective, how are you navigating prior authorization and coverage challenges, and denials for newer second-line agents? What strategies have been most effective to overcome a denial?

Led by the moderator, the panelists examined how cost considerations meaningfully enter treatment selection conversations at first relapse, particularly in the CAR-T versus bispecific decision, reframing the common perception of CAR-T as a prohibitively expensive therapy by contextualizing it as a potentially one-time investment that, if successful, eliminates ongoing treatment costs, compared to bispecific antibodies and triplet combinations which represent continuous expenditures that also carry the added costs of IVIg support, infection management, and hospitalizations over time. The discussion also addressed the operational and logistical challenges of bispecific therapy from a pharmacy standpoint, with the panelists identifying the assessment of site-specific resources as the foundational starting point while emphasizing the importance of continuously reevaluating and streamlining care processes to eliminate steps that do not add clinical benefit and reduce the cost burden associated with step-up dosing. The panelists further highlighted strategies for ensuring payer coverage of these therapies.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'From Pipeline to Practice: Preparing for New Approvals and Navigating Maintenance Therapy Decisions in Myeloma,' features the panelists advancing their conversation on multiple myeloma and focusing on how practices are preparing for a wave of anticipated approvals including new agents, formulations, and subcutaneous delivery methods, and how clinicians are currently approaching maintenance therapy decisions — including the evolving role of MRD-guided de-escalation and the questions that still need to be answered before the field reaches consensus.