Identifying health disparities in lenalidomide access

Abstract

IntroductionLenalidomide is dispensed through a limited distribution network, leading to longer prescription fill times. Acquiring lenalidomide involves navigating the risk evaluation and mitigation strategies (REMS) program, insurance prior authorization, and financial assistance for out-of-pocket costs. Health disparities, including socioeconomic status, health literacy, language barriers, and geography, can further delay access. This study aimed to identify and analyze factors contributing to delays in access to lenalidomide.MethodsThis retrospective study used electronic health records within the Brown University Health system to identify adults newly diagnosed with hematologic malignancies between June 1, 2019 and June 1, 2024, with a lenalidomide prescription. A stepwise multiple linear regression evaluated factors affecting dispensation time. The primary endpoint was to identify factors contributing to delays in lenalidomide acquisition from a health equity perspective. The secondary endpoint was to determine the median time from prescription generation to dispensation.ResultsWe included 328 patients with a mean age of 71 years; 53% were male and 80% were White. Comorbidities included cardiovascular disease (53%), diabetes (15%), obesity (21%), respiratory disease (8%), and chronic kidney disease (7%). Eighteen percent of patients required transportation assistance. The primary endpoint revealed 54% required financial assistance, which was associated with delayed lenalidomide dispensation (P < 0.05). The secondary endpoint showed a median time of 8 days (IQR, 5-14) to dispense the prescription.ConclusionThis study found that lenalidomide prescriptions took a median of 8 days to fill, with those requiring financial assistance experiencing longer delays. These findings suggest that insurance processes and health disparities hinder timely access.

Keywords: Multiple myeloma; health disparities; lenalidomide.