Improving Patient Access to Therapies for Chronic Graft vs Host Disease

Meilin Diaz-Paez, MSN, APRN, FNP-BC, AOCNP, BMTCN, advanced practice registered nurse, Division of Transplantation & Cellular Therapy, University of Miami Sylvester Comprehensive Cancer Center, describes what payers should know about patients with chronic graft vs host disease, including barriers that prevent access to timely care.

This interview is part of the series, "Current Treatments and Unmet Need in Chronic Graft vs Host Disease."

Read the full transcript:

My name is Meilin Diaz-Paez, and I am a family certified nurse practitioner. I currently work at the University of Miami Sylvester Comprehensive Cancer Center with the Division of Transplantation & Cellular Therapy. I have been a nurse practitioner with transplant for about seven years and spent an additional seven years as a registered nurse at the bedside.

What challenges might prevent patient access and/or provider uptake of therapies for chronic GVHD?

Related to patients, challenges will be cost and type of insurance coverage. Typically, third-line agents may require prior authorization, sometimes even appeals.

From a provider's point of view, it's very important to have comprehensive documentation to support the provider's choice of treatment regimen and to be knowledgeable on treatment lines and the use of medications. Sometimes we do need to provide evidence-based practice or clinical trials information to support the use of such agents in chronic GVHD with some insurance companies.

Another challenge might be geographical location and patients’ ability to get to a tertiary transplant center where they can have early identification of their chronic GVHD symptoms to start treatment properly. And also lack of patient education on what symptoms may be chronic GVHD that would prompt them to seek medical care.

From a provider standpoint, I think typically it'd be more of the provider not having familiarity with chronic GVHD, how to assess and grade it appropriately, and how to treat it effectively.

How can patient access to available therapies be improved?

As I mentioned, providers in rural areas can refer patients to tertiary transplant centers for GVHD consults and comanagement. The good thing is since the pandemic, visits can be telehealth and can be done in the primary care physician's office to allow for accurate physical assessment and appropriate grading. And more patients can then be provided more options for treatment that is appropriate.

What should payers understand about patients with chronic GVHD and the treatment options available to them?

Patients with chronic GVHD, for the most part, have poor quality of life. They have depression and physical disabilities that hinder them from being able to work, and therefore may not have the financial means to pay for high-cost medications, frequent doctor visits and treatments, required copayments, and travel. Money is needed for gas, and again, for travel time, they're required to take time off from work.

These things all increase the financial burden to these patients, which is even more important as to why payers should try to make that process a lot easier for them.

Is there anything else you would like to add?

It’s important to know that managing chronic GVHD is a multidisciplinary effort. It is important to have a good medical team that communicates and can provide primary care. You definitely want a primary care physician involved.

You want the transplant team involved. Social services can assist with any physical therapy and occupational therapy that might be needed in these patients that have physical disability from their chronic GVHD. Social services can also help with patient assistant programs that might be required for some of these high-cost medications.

A pulmonary team is needed for respiratory treatments for patients who have pulmonary involvement. Infectious disease professionals too, because a lot of patients do tend to be on two or more immunosuppressive therapies that may require some prophylactic medications, which also tend to be costly. Dermatology should be involved, GI, orthopedics—the list can continue, all dependent on the needs of the patient at the time.

This transcript has been edited for clarity.