Delays in time to first lenalidomide prescription fill for multiple myeloma.

170 Background: The complex process of obtaining lenalidomide can be delayed both before it is prescribed (due to risk evaluation and mitigation strategy [REMS] program requirements) and while filling the prescription (insurance prior authorization process, navigating patient support programs to help pay for out-of-pocket costs, and dispensing only via specialty pharmacies). However, these delays have not been well quantified or compared to delays for cheaper medications for the same indication. Methods: This retrospective cohort study used a myeloma patient registry at a large, integrated health system in Ohio and Florida to identify adults with newly diagnosed multiple myeloma between January 1, 2017, and December 31, 2023 who had prescriptions for both lenalidomide and oral corticosteroids. Data from electronic health records, including linked Surescripts dispensation records, captured time from the first available prescription order to fill, with follow-up through October 31, 2024. For each drug, we calculated the proportion of patients who filled their first prescription within 7 days. A multivariable Cox regression model was used to examine the association of sociodemographic and clinical variables with filling lenalidomide within 7 days. Results: We identified 556 patients with a mean age at diagnosis of 67.0 ±10.5 years; 53.4 % were male, 76.4% White, 20.5% Black, 5.4% of Hispanic ethnicity, covered by private insurance (33.5%), traditional Medicare (30.0%), Medicare Advantage (25.2%), Medicaid (7.2%), dually-eligible (3.1%) and self-pay/other (1.1%). Overall, 52.5% of lenalidomide and 87.8% of oral corticosteroids were filled within 7 days. Among those with filled prescriptions, the median time to fill was longer for lenalidomide (6 days, interquartile range [IQR], 2-12) than for oral corticosteroids (0 days [same day fill], IQR, 0-0, P<.001). In the multivariable Cox regression model, Medicaid insurance (vs. traditional Medicare, adjusted hazard ratio [aHR], 0.53, 95% CI, 0.29-0.96) and treatment at Florida hospitals (vs. Taussig Cancer Center, aHR, 0.64, 95% CI, 0.43-0.96) were negatively associated with filling a prescription within 7 days. Diagnosis during an inpatient admission approached but did not reach significant levels (aHR, 0.74, 95% CI, 0.52-1.06); other socio-demographic and clinical variables were not significant. Conclusions: Among patients with newly diagnosed multiple myeloma, it took almost a week to fill a prescription for lenalidomide and one in four took 12 days or more. Patients with Medicaid experienced worse delays. Most patients had oral corticosteroids filled on the same day, indicating that administrative and insurance-related barriers are likely responsible for not obtaining timely treatment.