Analysis of an oral anticancer repository program and the impact on access to care.

Abstract

1506 Background: Patients with cancer face many barriers to timely access of oral anticancer agents, including financial toxicity and delays in insurance and patient assistance program (PAP) approval. The Ohio State University Comprehensive Cancer Center (OSUCCC) launched a pharmacist-led Oral Oncology Drug Donation Repository (OODDR) program in 2020 to allow patients to donate unused oral anticancer medications with the intent to re-dispense to other patients in need. The goal of this study was to describe our OODDR experience and its impact on access to anticancer care. Methods: A retrospective chart review was conducted for OSUCCC patients who received at least one dispense of oral anticancer medication from the start of the program in February 2020 through August 2025. Data were collected on patient characteristics, anticancer therapy, barriers to access, and long-term medication access outcomes. Results: A total of 392 medication access encounters were identified for 376 patients through OODDRR dispense reports. Four encounters were excluded for missing data or not starting treatment, leaving 388 encounters for analysis. The median age of patients was 65 years, majority were female (51%), white (83%), and had commercial insurance (38%), Medicare (39%), or were uninsured (18%). The most common treatment indications included breast (23%), leukemia (17%), lymphoma (15%), and gastrointestinal (13%) malignancies. The OODDR dispensed 53 unique medications, mostly for on-label indications (76%), with 91% of encounters dispensing one treatment cycle/month or less (median 14 days [IQR 10-28]). Patients accessed long-term drug supply primarily via manufacturer PAP (42%) or insurance approval (31%), while 28 patients (7%) received the full course of treatment with OODDR supply. Reasons that repository supply was utilized included (multiple may apply): delay in prior authorization or appeal process (25%), delay in drug delivery from pharmacy (22%), delay in PAP approval and/or supply delivery (30%), and loss or change of insurance/assistance (19%). The OODDR notably improved the time from treatment decision to initiation with a median start of 6 days (IQR 1-13 days) compared to 14.5 days (IQR 6-30 days) to non-repository drug access. The average retail cost of drug dispensed per encounter was $10,789.28. Utilizing repository supply when patients required inpatient treatment (19%) resulted in hospital savings of $207,654.78. In total, the OODDR provided more than $4.1 million worth of anticancer treatment at no charge. Conclusions: The OSUCCC OODDR is an instrumental resource for patients and care teams to remove barriers and improve access to anticancer medications. Patients were able to initiate therapy sooner using the OODDR than would have otherwise been possible using routine insurance and assistance programs. Future efforts to improve medication access and awareness of medication assistance platforms are vital.