Limits to anti-nausea pill coverage wear on cancer patients and doctors

Cancer patients can ward off waves of vomiting after treatment with a relatively cheap anti-nausea pill, but some are running into coverage limits. Pharmacy benefit managers say their limits guard against overuse, and they offer workarounds to get more tablets. In between sit patients, who might ration pills or opt for less effective help for a dreaded side effect of radiation or chemotherapy. “This is sort of the dirty underbelly of the current health care environment,” said oncologist Dr. Fumiko Chino. “Insurance companies and pharmacy benefit managers are somehow weirdly ending up in my exam room, standing between me and my patients.” Steven Manetta takes at least a half dozen pills daily to help keep a form of leukemia in remission. For more than a year, he rationed his go-to anti-nausea pill, ondansetron, known by the brand-name Zofran. Cancer patient Steven Manetta sits for a portrait in his Lemont, Ill., home with four of the five medicines he takes daily to battle the nausea from his chemotherapy. (AP Photo/Charles Rex Arbogast) “It’s just like an extra thing to think about all the time,” the 33-year-old Lemont, Illinois, resident said. “When you’re on so many medications, the ones with the least side effects are the ones you always want to reach for.” Ondansetron hit the U.S. market more than 30 years ago. It was the first in a series of drugs that gave doctors a better way to control nausea and vomiting, said Dr. Alexi Wright, a Dana-Farber Cancer Institute oncologist who teaches at Harvard. Wright and other cancer specialists call ondansetron a cornerstone treatment because of its relative safety, effectiveness and limited side effects. More than half the plans sold on the U.S. individual insurance marketplace limit the number of ondansetron tablets that patients can get, according to preliminary results from a study by Chino and Michael Anne Kyle, a University of Pennsylvania researcher. Julia Manetta applies an anti-nausea patch on the neck of her husband, Steven, a cancer patient. (AP Photo/Charles Rex Arbogast) Pharmacist Yen Nguyen frequently sees these restrictions, including the limits from CVS Caremark that Manetta encountered. “Over four or five months of chemotherapy, you’re fighting for dimes and nickels here,” said Nguyen, executive director of pharmacy for the Houston-area practice Oncology Consultants. “It freaked me out,” the Tehachapi, California, resident said. That helps provide “maximum dosing” for seven days of treatment a month, chief clinical officer David Lassen said in an email. Julia Manetta, left, and her husband, Steven Manetta, a cancer patient, work on dinner. (AP Photo/Charles Rex Arbogast) Julia Manetta feeds Basil a piece of watermelon as she and her husband, Steven, prepare dinner Thursday, Aug. 29, 2024, in their Lemont, Ill., home. Coverage limits vary, and some patients may not tell their doctor that they got a smaller-than-desired amount. Chino says she wants patients to start with 90 tablets of ondansetron, enough to take the drug three times a day for a month if needed. “The fact that there’s still restrictive patterns on this very useful medication is insane,” said Chino, who recently moved from Memorial Sloan Kettering in New York to MD Anderson in Houston. An entry in a journal that Julia Manetta wrote as part of her wedding vows to her husband, Steven. (AP Photo/Charles Rex Arbogast) Steve and Julia Manetta take their dog Basil for a walk after dinner Thursday, Aug. 29, 2024, in Lemont, Ill. (AP Photo/Charles Rex Arbogast) Limits can hurt patients who have big copayments for each refill or trouble getting to the drugstore, noted Dr. Ramy Sedhom, an oncologist and palliative care specialist with Penn Medicine Princeton Health. “I have a lot of patients who only go to the pharmacy once a month when their niece or nephew is in town to pick up the (prescriptions),” he said. If patients run out of ondansetron, even for a few days, uncontrolled vomiting can send them to emergency rooms or force a treatment pause, doctors say. (AP Photo/Charles Rex Arbogast) Murphy, the cancer patient, has avoided all of that. “I would hate to not have it,” she said. – This Summarize was created by Neural News AI (V1). Source: https://apnews.com/c73a6d1d8ad20108319473d083ee81d2