Hematopoietic Cell Transplantation and Utilization of Fertility Preservation Services.

Conditioning regimens for hematopoietic cell transplantation (HCT) are harmful to reproductive function, but national utilization of fertility preservation (FP) before HCT has not been studied. The primary aim of this descriptive retrospective analysis is to understand FP utilization in the HCT population of patients between ages 18 and 40 years, whereas the secondary aim is to describe temporal trends in FP before HCT. Key dates, procedures codes, and diagnosis codes were extracted from administrative and health services commercial claims data, which were obtained from FAIR Health's national claims database, to construct 29 patient-specific clinical journey timelines detailing the time from diagnosis to FP and to HCT. Patient characteristics studied include sex, age, HCT type (autologous and allogeneic), and census region. Key findings from primary and secondary analyses were that 7% of the HCT cohort had claims for FP services, FP utilization before HCT decreased with increasing age, there were 102 days (median) between FP and HCT procedure date, and 7 of 29 patients who received FP services had a nonmalignant primary indication for HCT. More research is needed to understand the barriers to FP before HCT so that targeted tools can be used to increase utilization and improve quality of life for HCT survivors.

Challenges around Access to and Cost of Life-Saving Medications after Allogeneic Hematopoietic Cell Transplantation for Medicare Patients.

Hematopoietic cell transplantation (HCT) is an expensive, medically complicated, and potentially life-threatening therapy for multiple hematologic and nonhematologic disorders with a prolonged trajectory of recovery. Similar to financial issues in other cancer treatments, adverse financial consequences of HCT are emerging as an important issue and may be associated with poor quality of life and increased distress in HCT survivors. Prescription medicine coverage for HCT for Medicare and some Medicaid beneficiaries, especially in the long-term, remains suboptimal because of inadequate payer formularies or prohibitive copays. With an increasing number of older patients undergoing HCT and improvement in the overall survival after HCT, the problem of financial burden faced by Medicare beneficiaries with fixed incomes is going to worsen. In this article, we describe the typical financial burden borne by HCT recipients based on estimated copayment amounts attached to the categories of key medications as elucidated through 2 case studies. We also suggest some possible solutions for consideration to help these patients and families get through the HCT by minimizing the financial burden from essential medications needed during the post-HCT period.