Most Specialty Oral Anticancer Meds for Blood Cancers Are Initially Rejected by Insurers

FRIDAY, Oct. 9, 2026 (HealthDay News) — Access barriers to specialty oral anticancer medications (SOAMs) for blood cancers include rejection by insurance and high out-of-pocket costs, according to a study published online Sept. 30 in the Journal of Clinical Oncology.

Jalpa A. Doshi, Ph.D., from the University of Pennsylvania, and colleagues examined approval and fill rates of SOAM prescriptions indicated for blood cancers in a nationwide sample of Medicare and commercially insured patients using nationwide claims. The study included 12,134 patients with one or more SOAM prescriptions during 2022.

The researchers found that few prescriptions were both approved and filled initially (9.6 percent Medicare; 4.0 percent commercial). Most prescriptions were initially rejected by insurers (64.9 percent Medicare; 84.0 percent commercial), often due to prior authorization or formulary restrictions. Approval rates increased to 85.0 and 62.8 percent with Medicare and commercial insurance, respectively, by 90 days, but many approved prescriptions were never filled; only 54.5 and 45.5 percent of Medicare and commercial patients both received insurer approval and filled their prescription. When out-of-pocket costs exceeded $175, fill rates dropped sharply; the lowest rates were seen at out-of-pocket costs of $500.01 to $2,000 for Medicare patients (29.2 percent) and at $2,000 or more for commercially insured patients (21.6 percent). Rates were similar after adjustment.

“These blood cancer medications can be life-prolonging, but our findings show that insurance coverage requirements and high out-of-pocket costs can delay or limit access,” Doshi said in a statement.

Two authors disclosed financial ties to the biopharmaceutical industry.

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