When Treatment Advances Aren't Enough: The Solution to Cancer Therapy Hurdles

It seems everyone today has been impacted by cancer in one form or another, whether a friend or family member has had the disease or they are coping with the condition themselves. According to the American Cancer Society, 40 out of 100 Americans will develop cancer in their lifetime.[1] With early detection and the treatment advances we’ve seen, there is hope of a cure or long-term remission; however, many cancer treatments are not easy and pose challenges for patients.

As a pharmacy benefit manager (PBM), Elixir believes that our responsibility to members goes beyond simply providing access to medications. That is why we have developed a solution to managing oncology treatments that helps members overcome these obstacles and improve their quality of life.

Barriers to Effective Cancer Treatment

While the incredible treatment options we have available today can do so much in the fight against cancer, the side effects can often be intolerable. If side effects become too severe, healthcare providers may be forced to reduce dosages, change therapy or even discontinue the potentially lifesaving treatment altogether. Any of these options could lead to less optimal therapy. It is important to find safe and effective ways to manage side effects that allow continuation of the preferred therapy.

Another hurdle to cancer treatment can be the costs. Some new cancer treatments can be over $100,000 per year.[2] This can be a financial hardship for some. In fact, one study found that 20% of cancer patients took less than the prescribed amount of their medication to save money. Additionally, 19% only filled part of their prescription and 24% avoided filling their prescriptions altogether.[3]

Delivering Better Cancer Treatment Outcomes and Plan Savings

Supporting the patient through their oncology treatment is critical to their success and safety. Elixir provides a thoughtful approach to the care of members fighting cancer. To ensure optimal outcomes, we provide:

• Condition-focused clinical controls with dynamic prior authorization criteria that provides the reassurance members are receiving the right medication at the right time.
• Integration with the specialty pharmacy, whether Elixir Specialty or another specialty pharmacy, to provide care teams with full visibility into the member’s care to provide better, data-driven clinical guidance.
• Insightful data with expert analysis that can reduce costs and close care gaps.
•  Individualized support from the very first member interaction, helping the patient manage side effects and overcome therapy hurdles to improve treatment outcomes and quality of life.

Knowing that every patient’s story is unique, we provide a proactive, hands-on approach that is disease and drug specific, as well as tailored to each member’s individual needs. We help members manage side effects to remain on the most optimal treatment and manage costs by avoiding the waste of costly medication.

There are 16.9 million Americans surviving today with a past cancer diagnosis.{1} As treatment options evolve to fight this devastating disease, Elixir will continue to provide the support patients need to optimize therapy and improve the quality of life.

[1} American Cancer Society (2020). Cancer Facts & Figures 2020.

[2] Kantarjian, Hagop, et a (2014). High Cancer Drug Prices in the United States: Reasons and Proposed Solutions. Journal of Oncology Practice. Vol. 10, Issue 4, July 2014.

[3] Zafa, S, et al (2013). The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience.