Payer-Imposed Quantity Limits for Antiemetics: Everybody Hurts.

Antiemetics represent one of the greatest advances in modern oncology; perhaps no other intervention has improved the quality of life of people receiving anticancer therapy more than antiemetics. 1 Nausea and vomiting are also dose-limiting toxicities that can prevent the intended therapy administration. Unfor-tunately, payer-imposed quantity limits serve as a barrier to patient access to essential medications such as antiemetics. 2 In this Editorial, we describe quantity limits of antiemetics, discuss the incentives that drive them, explore potential harms they cause, and provide recommendations for improving access.

[1]  S. Dy,et al.  Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms , 2021, JCO oncology practice.

[2]  S. Dy,et al.  Use of Peripheral μ-Opioid Receptor Antagonists for Treating Opioid-Induced Constipation among US Medicare Beneficiaries from 2014 to 2018. , 2021, Journal of palliative medicine.

[3]  M. Kris,et al.  Antiemetics: ASCO Guideline Update. , 2020, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  T. Leblanc,et al.  What the HEC? Clinician Adherence to Evidence-Based Antiemetic Prophylaxis for Highly Emetogenic Chemotherapy. , 2020, Journal of the National Comprehensive Cancer Network : JNCCN.

[5]  Laura A. Levit,et al.  Impact of Pharmacy Benefit Managers on Oncology Practices and Patients. , 2020, JCO oncology practice.

[6]  Illhoi Yoo,et al.  Patient-Related Risk Factors for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review , 2020, Frontiers in Pharmacology.

[7]  M. Kulldorff,et al.  Variation in Prescription Drug Prices by Retail Pharmacy Type , 2019, Annals of Internal Medicine.

[8]  E. Basch,et al.  Characterizing and assessing antiemetic underuse in patients initiating highly emetogenic chemotherapy , 2019, Supportive Care in Cancer.

[9]  C. Nabhan,et al.  How Pharmacy Benefit Managers Add to Financial Toxicity: The Copay Accumulator Program. , 2018, JAMA oncology.

[10]  K. Ruddy,et al.  Inpatient hospitalization costs associated with nausea and vomiting among patients with cancer. , 2018, Journal of Clinical Oncology.

[11]  N. Lin,et al.  Increasing Burden of Prior Authorizations in the Delivery of Oncology Care in the United States. , 2018, Journal of oncology practice.

[12]  E. Balaban.  Prior Authorization: This Will Take Time. , 2018, Journal of oncology practice.

[13]  A. Jatoi,et al.  What occurs in the other 20% of cancer patients with chemotherapy-induced nausea and vomiting (CINV)? A single-institution qualitative study , 2018, Supportive Care in Cancer.

[14]  D. Patt.  Understanding Utilization Management Policy: How to Manage This Increasingly Complex Environment in Collaboration and With Better Data. , 2018, American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting.

[15]  Yujin Park,et al.  The Effect of Formulary Restrictions on Patient and Payer Outcomes: A Systematic Literature Review. , 2017, Journal of managed care & specialty pharmacy.

[16]  W. Encinosa,et al.  Changes in Antiemetic Overuse in Response to Choosing Wisely Recommendations , 2017, JAMA oncology.

[17]  American Society of Clinical Oncology Statement on the Impact of Utilization Management Policies for Cancer Drug Therapies. , 2017, Journal of oncology practice.

[18]  B. Gyawali,et al.  Cheaper Options in the Prevention of Chemotherapy-Induced Nausea and Vomiting , 2016, Journal of global oncology.

[19]  B. Rapoport,et al.  Study of rolapitant, a novel, long-acting, NK-1 receptor antagonist, for the prevention of chemotherapy-induced nausea and vomiting (CINV) due to highly emetogenic chemotherapy (HEC) , 2015, Supportive Care in Cancer.

[20]  Gaetano Rocco,et al.  Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  R. Schilsky,et al.  American Society of Clinical Oncology 2013 top five list in oncology. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  R. Navari,et al.  The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy , 2013, Supportive Care in Cancer.

[23]  Thomas J. Smith,et al.  American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  M. Kris,et al.  Antiemetics: American Society of Clinical Oncology clinical practice guideline update. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  D. Coyle,et al.  Costs of treating and preventing nausea and vomiting in patients receiving chemotherapy. , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.