Suboptimal TKI Adherence Across Payer Types Among Patients With CML

Key Takeaways:

• In a study size of 2141 patients with chronic myeloid leukemia (CML), less than one fourth remained treatment adherent for 6 months after initiation, despite nearly 75% receiving prescription approvals.
• Patients with Medicare and Medicaid had higher rates of prescription approval compared to those with commercial insurance.
• Factors associated with treatment approval, fill, and adherence included insurance type, age, and out-of-pocket costs.

Researchers conducted a retrospective claims study to assess rates of prescription approval and treatment adherence among patients with CML according to insurance type.

Study Methods and Outcomes

Using the Symphony Health Solutions Integrated Dataverse database, investigators identified patients with CML with at least 1 tyrosine kinase inhibitor (TKI) prescription in 2022.

Outcomes included rates of TKI approval by payers within 90 days of prescription, fill within 90 days of approval, and treatment adherence for 6 months after first fill. Researchers also used logistic regressions to evaluate factors associated with each outcome.

Prescription Approval and Access According to Insurance Type

The study included 2141 patients with CML with prescribed TKIs. The percentages of patients with Medicare, commercial insurance, and Medicaid were 53.0%, 39.4%, and 7.6%, respectively.

Generic imatinib was the most commonly prescribed TKI, with 50.1% of study participants receiving the treatment. All outcomes were slightly higher among patients with generic imatinib compared to patients with brand TKIs.

Among the 2141 study participants, 74.7% received TKI approval from insurers, of whom nearly two thirds (64.1%) filled their prescription. Among those with filled prescriptions, 41.9% were adherent for 6 months after treatment initiation, representing only 20.0% of the total study population.

Prescription approval was higher among Medicare and Medicaid beneficiaries compared to commercial beneficiaries, and Medicaid beneficiaries had higher rates of treatment adherence compared to the other cohorts.

Factors Associated With TKI Approvals, Fills, and Adherence

TKI approval was associated with older patients, those with increased comorbidity, and individuals living outside of the northeast.

Patients with higher out-of-pocket costs were less likely to fill their prescription than patients with lower costs.

Older age and Hispanic ethnicity were associated factors of treatment adherence.

Implications for Managed Care

These findings highlight suboptimal treatment adherence among patients with CML, with less than half of patients with filled prescriptions remaining adherent for 6 months.

Insurance type and out-of-pocket spending had the greatest impact on TKI approval and fills, with Medicare and Medicaid beneficiaries having more access compared to commercial beneficiaries.

The authors concluded, “Legislative efforts may be needed to facilitate access to life-extending therapies such as TKIs, particularly among the commercially insured.”

Reference

Li P, Shukla A, Lin J, Geng Z, Huntington S, Doshi J. Real-world rates of tyrosine kinase inhibitor prescription approval, fill, and adherence and associated factors in a national sample of patients with chronic myeloid leukemia. Blood. 2026;146(1):2651. doi:10.1182/blood-2025-2651