How Group Purchasing Organizations Affect Access to LEMS Therapy

This episode, "How Group Purchasing Organizations Affect Access to LEMS Therapy," features the specialty panel examining an underexplored piece of the access puzzle.

Dr. Patel asks Dr. Iams to switch hats and address the role of group purchasing organizations (GPOs) in LEMS care. Dr. Iams explains that GPOs primarily work with large community oncology practices and serve as the front-facing negotiator for oncolytic and antineoplastic drugs broadly. He notes that amifampridine occupies a specialized pocket within that broader drug category, which makes its GPO relationship somewhat different, and admits he is not certain how GPO interactions with amifampridine will be affected. He points out that, as both physicians have discussed, the drug is not approached like a typical chemotherapy regimen for small cell lung cancer, so exactly how it fits remains yet to be defined, but something clinicians need to stay attuned to. Dr. Patel follows with a series of practical questions: whether a given GPO actually has access to the medication when needed, and what current barriers exist, suggesting that a general lack of awareness about the drug may be the most significant one. He asks how Dr. Iams thinks GPOs can incorporate the latest NCCN guideline updates into their own decision-making. Dr. Iams responds that GPOs should take the same approach as other third-party payers, using NCCN guideline inclusion as the linchpin for coverage decisions, since that is typically how drug approval or denial gets determined across payers. He adds that there should be both willingness and ability to recognize this as an important clinical issue given the guideline support behind it. At the same time, he acknowledges that the rarity of the LEMS patient population may keep the drug relatively low on a GPO's overall radar, even with guideline backing in place.

Up next, in "Making the Case for Earlier LEMS Screening to Payers," the panel closes with their strongest pitch for why payers should prioritize earlier LEMS screening.