Improving Access to Cancer Therapeutics Through Stakeholders Engagement: 2-Years’ Experience in the Largest Private Healthcare Provider in Oncology in Brazil

OBJECTIVES: The rapid development and increasing cost of new cancer drugs creates several barriers to patient access. In our largest Oncology Network in Brazil, a Medical Access Support program has been implemented in line with the top 10 HEOR trends for 2022-2023 identified by ISPOR. We aimed to evaluate the effectiveness of the program after two years of experience.

METHODS: We estimated the rate of approvals and court cases in our interventions, focusing on cases with serious barriers to access, such as off-label use or without mandatory coverage by supplementary healthcare.

RESULTS: We received a total of 786 cases from the 36 units, an average of 33 cases/month. Ninety-two cases (11.7%) did not meet the criteria for evidence-based medicine. The average time for the first response from medical support team was 0,84 days and the average time to complete the review process was 2.05 days. We have taken action in 694 cases, of which 511 have a known outcome. Among the 616 cases with serious barriers to access, 50,9% were approved while 14,1% were refused by payers. There are 11.3% of cases under review by payers, 13.3% in disagreements and 10.2% of requests for cancellation. To date, 6,89% of the refused cases have been referred to the courts.

CONCLUSIONS: The Medical Access Support program showed promising results over a two-years period and is establishing itself as a key strategy for the company. Notable achievements include rapid and equitable access to treatment for more than half of the patients recruited, despite regulatory barriers to access. It promotes system sustainability and reduces litigation. Additionally, its role as an interface between the clinical team and stakeholders enables more accurate decision making, adding value to healthcare. Continued evaluation is recommended to explore its potential in different contexts and to assess its long-term impacts.