ALBERT

Description: Introduction: Treatments for myeloma have evolved over the past several years with resultant improvements in survival. Two new medications, bortezomib (B) and lenalidomide (L), have played a major role in this development. Each has received FDA approval in the past 10 years. Both medications are relatively expensive and, due to its teratogenic effects, lenalidomide requires a pt training and education program before pharmacies may fill the prescription. In addition, specialty pharmacies need to be identified and prior approval is required from the insurance carrier. This study addresses whether or not a relatively underinsured, indigent population was able to receive these medications and in a timely fashion. Methods: Electronic medical records of all pts diagnosed with myeloma from 1/2005-12/2014 at MetroHealth Medical Center (a large safety net institution in Cleveland, OH) were reviewed. 88 pts were identified. Med age was 59 (35 -87); 50% were African American (AA), 43% caucasian (C), 1% Hispanic and 6% unknown. Health insurance status: 26% private; 35% medicare; 17% medicaid; and 22% were uninsured. Results: 77% AA received either B or L or both vs 82% C pts (NS). Overall, 17/88 (19%) never received either L or B. This included: 5 due to pt preference or co-morbidities which precluded treatment,; 2 who died before they could receive any therapy; 3 lost to follow-up before treatment could be started; 6 who received thalidomide and then either transferred care elsewhere, died or did not require another treatment; and 1 who transferred to another facility for stem cell transplant evaluation before treatment was initiated. Therefore, all 71 pts who were candidates and w/treatment data available received B or L. Of the 17 who did not get B or L: 6 were uninsured, 5 private insurance, 4 medicare, and 2 medicaid. Overall, 66 pts received B; 31 received L. Ave time from prescription to pt start of medication: 19.1 days for L (med 14.5d, range 0-65d) vs 1.56d for B (med 0d, range 0-20d), p