The discontinuation of oral oncology medications before the full-month supply has been finished results in medication waste, leading to increased costs for patients and for payers. Split fills allow for a 14- to 16-day supply for oral oncology medications rather than a full 28- to 30-day supply. Researchers compared the discontinuation rates, patient-reported adverse events, estimated pharmacy costs, and potential waste in patients with pharmacy benefit designs that included a split-fill option with patients who did not have this option (Staskon FC, et al. J Oncol Pract. 2019;15:e856-e862).
This retrospective cohort study included patients who were new to therapy with one of the 11 split-fill oncology oral medications within the managed program, between September 2015 and August 2017. Patients using split-fill and non–split-fill medications were matched by age, sex, state census areas, index medication, start date, and the use of >1 medication. The study included 2363 patients within the managed program who met the selection criteria for the 11 medications, and 671 patients from each group were matched.
The per-month medication discontinuation rates were assessed for each group. The monthly utilization trends indicated a significantly higher persistency rate for the split-fill cohort than the non–split-fill cohort in the second month (71.6% vs 67%, respectively; P <.001). Payers participating in a split-fill program had mean average wholesale price (AWP) savings of $2147.60 at 1 month and $928.60 at 6 months. Based on modeled waste, payers without a split-fill program could expect to save $2646.74 AWP monthly if they moved to the split-fill option.
Both cohorts had similar rates of adverse effects (55.3% for the split-fill cohort vs 56.4% for the non–split-fill cohort). The time until the first reported adverse effect trended toward being earlier for the split-fill group, but not significantly earlier.
“Even after noted modifications were made for new therapies, the split-fill patient managed component had lower discontinuation rates, significantly reduced pharmacy costs, and reduced potential wastage,” concluded the researchers. “By adopting a split-fill option, insurance payers have a means of reducing the pharmacy cost for new oncolytic therapy drugs, providing additional benefits to patients regarding copay, and addressing adverse events.”