Clinical Progress and Coverage Policies in Immuno-Oncology - Episode 22
Benjamin P. Levy, MD: The issue is when patients are not eligible for patient-assistance programs. I will tell you, I have not had any trouble, thus far, getting these immunotherapy drugs approved. Interestingly enough, I don’t think many physicians, at least in the Northeast, are having trouble getting these drugs approved as a second-line, or getting them paid/covered, or even approved in the first-line. I think these patients are getting immunotherapy as a first-line and getting covered by insurance. I’ve seen several of these as second opinion. I’ve had very little out-of-pocket expenses, that I’ve heard about at least, from my patient population.
And there’s philanthropy in industry that’s certainly helping out. But we’ve treated a lot of these patients on clinical trials. Of course, we don’t have any issue there. But for the patients who’ve gotten nivolumab or pembrolizumab as standard-of-care, I haven’t heard anything from my patients that they’ve gotten a bill. That’s the really simple question from me: are you getting a bill? And I think, for the most part, we haven’t had any trouble with payers covering this, and they should be. I think there’s a lot of interest, at least in the media, about the cost of these drugs. There was a Time magazine cover recently about the role of immunotherapy. But, interestingly, it was on the cost of immunotherapy. If you’re sitting in my shoes and you see the differences between outcomes, between a patient who’s responding to immunotherapy versus a patient who’s getting chemotherapy, I think it really speaks volumes. So, we haven’t had trouble getting it covered thus far.
I know patient-assistance programs are through industry, but I would really reach out to industry and find a way. I’m not going to give a patient a drug if they’re going to get stuck with a bill. That’s the bottom line. My patients are already strapped enough as they are. It’s going to be me, or, admittedly, my nurse practitioner, getting on the phone with either that industry or other philanthropies to see if we can get the drug approved.
It’s rare. And I’m not speaking to experience. I don’t have experience yet with patients not having coverage for this drug. In fact, every immunotherapy that we deliver as standard-of-care goes through our authorization department prior to being given. To my knowledge, we have not had any issue getting these drugs approved. I may be the rare exception, and this may not be indicative of the community or other academic centers, so I can’t speak intelligently about what we do in those cases. I will say, when we’ve had problems with targeted therapies, and we have, there have been some very good payer-assist programs through the industry, or through philanthropy, that will help. And we have really good social workers who help out with this.