National survey of patient perspectives on cost discussions among recipients of copay assistance

Author:

Lam Anh B1ORCID,Nipp Ryan David2,Hasler Jill S3,Hu Bonnie Y4,Zahner Greg J5,Robbins Sarina6,Wheeler Stephanie B7,Tagai Erin K3,Miller Suzanne M3,Peppercorn Jeffrey M5

Affiliation:

1. University of Oklahoma Health Sciences Center Department of Medicine, , Oklahoma City, OK 73104 , United States

2. University of Oklahoma Health Sciences Center, Stephenson Cancer Center Section of Hematology and Oncology, Department of Medicine, , Oklahoma City, OK 73104 , United States

3. Fox Chase Cancer Center, Temple University Health System , Philadelphia, PA 19111 , United States

4. Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA 19104 , United States

5. Massachusetts General Hospital Section of Hematology & Oncology, Department of Medicine, , Boston, MA 02114 , United States

6. HealthWell Foundation , Germantown, MD 20874 , United States

7. University of North Carolina at Chapel Hill , Chapel Hill, NC 27599 , United States

Abstract

Abstract Background Individuals with cancer and other medical conditions often experience financial concerns from high costs-of-care and may utilize copay assistance programs (CAP). We sought to describe CAP recipients’ experiences/preferences for cost discussions with clinicians. Methods We conducted a national, cross-sectional electronic-survey from 10/2022 to 11/2022 of CAP recipients with cancer or autoimmune conditions to assess patient perspectives on cost discussions. We used multivariable logistic regression models to explore associations of patient perspectives on cost discussions with patient characteristics and patient-reported outcomes (eg, financial toxicity, depression/anxiety, and health literacy). Results Among 1,566 participants, 71% had cancer and 29% had autoimmune conditions. Although 62% of respondents desired cost discussions, only 32% reported discussions took place. Additionally, 52% of respondents wanted their doctor to consider out-of-pocket costs when deciding the best treatment, and 61% of respondents felt doctors should ensure patients can afford treatment prescribed. Participants with depression symptoms were more likely to want doctors to consider out-of-pocket costs (OR = 1.54, P = .005) and to believe doctors should ensure patients can afford treatment (OR = 1.60, P = .005). Those with severe financial toxicity were more likely to desire cost discussions (OR = 1.65, P < .001) and want doctors to consider out-of-pocket costs (OR = 1.52, P = .001). Participants with marginal/inadequate health literacy were more likely to desire cost discussions (OR = 1.37, P = .01) and believe doctors should ensure patients can afford treatment (OR = 1.30, P = .036). Conclusions In this large sample of CAP recipients with cancer and autoimmune conditions, most reported a desire for cost discussions, but under one-third reported such discussions took place.

Publisher

Oxford University Press (OUP)

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