Study Examines Cost-Sharing Trends in PARP Inhibitors for Ovarian Cancer

Whitney N. Goldsberry, MD

Out-of-pocket (OOP) costs for patients with ovarian cancer who have been treated with PARP inhibitors are generally low, according to recent study results from a single institution.¹

The study included 76 patients who filled 94 PARP inhibitor prescriptions from May 2015 to September 2019 at The University of Alabama in Tuscaloosa. Of these, 42 (45%) prescriptions were obtained using any type of financial assistance program. Investigators analyzed 232 prescription months for the 41 prescriptions with available cost data. These included 18 (44%) prescriptions for rucaparib (Rubraca; Clovis Oncology), 18 (44%) for niraparib (Zejula; GlaxoSmithKline), and 5 (12%) for olaparib (Lynparza; AstraZeneca).

The average total monthly drug cost was $12,422, with a median of $13,700. The monthly OOP cost for patients averaged $46 and the median was $0 (interquartile range [IQR], $0-$4). Payers had the highest monthly costs, with an average of $12,019 and a median of $13,662 (IQR, $9914-$14,709). Financial assistance programs contributed an average of $358 and a median of $0 per month (IQR, $0-$150). Patients with public (P < .01) or Medicare insurance (P < .01) had higher OOP costs than those without private insurance.

“About 75% of patients paid less than $5 a month for their prescriptions. And there were outliers—there was 1 patient in our study who paid more than $3000 for just a 1-month supply. Therefore, [regarding] the ability of patients to access [these drugs], copayments could be a potential financial barrier,” lead author Whitney N. Goldsberry, MD, said in an interview with the American Journal of Managed Care^®. She is a fellow at The University of Alabama’s Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology.

“The overall monthly cost of PARP inhibitors appeared to decrease from 2017 to 2019,” Goldsberry said. “Similarly, the monthly costs covered by payers appeared to decrease slightly, reflecting a decrease in the overall cost. Through this, the out-of-pocket cost actually remained very low. We did notice that the contribution of financial assistance programs did increase over time, which may reflect improved utilization of existing financial assistance programs. These trends will be very important as we move forward in the broader applications of these drugs.”

In the United States, the 3 PARP inhibitors are approved to treat patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy.

Additionally, rucaparib is approved to treat adult patients with epithelial ovarian, fallopian tube, or primary peritoneal cancer with deleterious BRCA mutation–associated (germline or somatic) and in the maintenance setting for patients who have responded to platinum-based chemotherapy regardless of BRCA status. The agent also is indicated for patients with BRCA-mutated metastatic castration-resistant prostate cancer after prior therapy. 

Clovis Oncology reported global net sales of $164.5 million for rucaparib in 2020, up 15% over 2019.²

Niraparib is also approved to treat adult patients with advanced ovarian, fallopian tube, or primary peritoneal cancer in maintenance settings and for patients previously treated for the disease whose cancer tests positive for homologous recombination deficiency (HRD) including BRCA mutations. GlaxoSmithKline reported global sales for the therapy of £339 million ($470 million) for 2020. 

Olaparib is also approved to treat patients with deleterious BRCA-mutated (germline or somatic) advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer; germline BRCA-mutated, HER2-negative metastatic breast cancer; germline BRCA-mutated metastatic pancreatic adenocarcinoma; and homologous recombination repair metastatic castration-resistant prostate cancer with mutations in homologous recombination repair genes. AstraZeneca reported 2020 sales of olaparib of $1.77 billion.⁴

To hear more of the interview with Goldsberry on the future of PARP inhibitors, visit bit.ly/3unkNAW.

References

1. Goldsberry WN, Summerlin SS, Guyton A, Huh WK, et al. The financial burden of PARP inhibitors on patients, payors, and financial assistance programs: who bears the cost? Gynecol Oncol. 2021;160(3):800-804. doi:10.1016/j.ygyno.2020.12.039
2. Clovis Oncology announces 2020 operating results. News release. Clovis Oncology Inc. February 23, 2021. Accessed February 24, 2021. http://www.bit.ly/3utqj5b
3. Full year and fourth quarter 2020. News release. GlaxoSmithKline. February 3, 2021. Accessed February 24, 2021. http://www.bit.ly/3kiGnC2 
4. Full-year 2020 results. News release. AstraZeneca PLC. February 11, 2021. Accessed February 24, 2021. http://www.bit.ly/3soW3Xj