• Pawlyn C, Davies FE. Toward personalized treatment in multiple myeloma based on molecular characteristics. Blood. 2019;133:660–675. Accessed 5 Feb 2023. https://pubmed.ncbi.nlm.nih.gov/30587529/. These articles provide background on the disease process of multiple myeloma, including the guidelines utilized for diagnosis. They also describe recent treatment advances and the current prevalence of multiple myeloma in the population.

• Dimopoulos MA, Moreau P, Terpos E, et al. Multiple myeloma: Eha-ESMO clinical practice guidelines for diagnosis, treatment and follow-up†. Accessed 5 Feb 2023. Ann Oncol. 2021;32:309–322. https://pubmed.ncbi.nlm.nih.gov/33549387/. These articles provide background on the disease process of multiple myeloma, including the guidelines utilized for diagnosis. They also describe recent treatment advances and the current prevalence of multiple myeloma in the population.

• Lawrence L. In Myeloma, New Drugs, Skyrocketing Price Tags. In: Ash Clinical News. 2019 Accessed 5 Feb 2023. https://ashpublications.org/ashclinicalnews/news/4501/In-Myeloma-New-Drugs-Skyrocketing-Price-Tags. Reference 3 outlines the development of multiple myeloma treatment, beginning in the 1990s and providing a timeline to the current state. It also includes an overview of the value that treatment has added to patients’ lives, including substantial increases in treatment response rates and 5-year survival rates. It describes the increasing costs of treatment, as well, stating that patients are struggling to afford the treatment options. Reference 4 discusses the current treatment regimen with preferred induction therapy in both transplant-eligible and transplant-non-eligible patients.

• Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol. 2022;97:1086–1107. Accessed 5 Feb 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387011/pdf/nihms-1824073.pdf. Reference 3 outlines the development of multiple myeloma treatment, beginning in the 1990s and providing a timeline to the current state. It also includes an overview of the value that treatment has added to patients’ lives, including substantial increases in treatment response rates and 5-year survival rates. It describes the increasing costs of treatment, as well, stating that patients are struggling to afford the treatment options. Reference 4 discusses the current treatment regimen with preferred induction therapy in both transplant-eligible and transplant-non-eligible patients.

•• Warren JL, Harlan LC, Stevens J, Little RF, Abel GA. Multiple myeloma treatment transformed: a population-based study of changes in initial management approaches in the United States. J Clin Oncol. 2013; 31(16):1984–1989. Assessed 25 March 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661935/. For understanding the Medicare and Medicare Advantage enrollment, volume of patients insured by Medicare vs. Medicare Advantage, and cost implications to patients and the Medicare trust fund.

•• Freed M, Fuglesten Biniek J, Damico A, Neuman T. Medicare Advantage in 2022: enrollment update and key trends. Kaiser Family Foundation website. August 25, 2022. Assessed 16 Apr 2023. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/. For understanding the Medicare and Medicare Advantage enrollment, volume of patients insured by Medicare vs. Medicare Advantage, and cost implications to patients and the Medicare trust fund.

•• Cubanski J, Neuman C. FAQs on medicare financing and trust fund solvency. Kaiser Family Foundation website. June 17, 2022. Assessed 13 Apr 2023.https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/. For understanding the Medicare and Medicare Advantage enrollment, volume of patients insured by Medicare vs. Medicare Advantage, and cost implications to patients and the Medicare trust fund.

•• Patel KK, Giri S, Parker TL, Bar N, Neparidze N, Huntington SF. Cost-effectiveness of first-line versus second-line use of daratumumab in older, transplant-ineligible patients with multiple myeloma. J Clin Oncol. 2021;39:10, 1119–1128. Assessed 16 Apr 2023. https://ascopubs.org/doi/pdfdirect/10.1200/JCO.20.01849. For background of cost/financial toxicity in multiple myeloma.

Jensen CJ. The high cost burden of third to fifth line treatments for multiple myeloma: unsustainable and unaffordable. J Manag Care Spec Pharm.;27(9):1321–1324. Assessed 10 Feb 2023. https://pubmed.ncbi.nlm.nih.gov/34464211/.

• Jaber N. FDA approves BCMA-targeted CAR T-cell therapy for multiple myeloma. In: National Cancer Institute 2021 Accessed 5 Feb 2023. https://www.cancer.gov/news-events/cancer-currents-blog/2021/fda-ide-cel-car-t-multiple-myeloma. This article describes two of the most recent advancements in multiple myeloma treatment. This includes CAR T-cell therapy and BCMA-targeted therapy. Their approval was a significant occurrence in the development of multiple myeloma care.

• Jaber N. Carvykti approval marks second CAR T-cell therapy for multiple myeloma. In: National Cancer Institute. 2022 Accessed 5 Feb 2023. https://www.cancer.gov/news-events/cancer-currents-blog/2022/fda-carvykti-multiple-myeloma. This article describes two of the most recent advancements in multiple myeloma treatment. This includes CAR T-cell therapy and BCMA-targeted therapy. Their approval was a significant occurrence in the development of multiple myeloma care.

•• Moreau P, Garfall AL, van de Donk NW, et al. Teclistamab in relapsed or refractory multiple myeloma. N Engl J Med. 2022;11;387(6):495–505. Assessed 10 March 2023.https://pubmed.ncbi.nlm.nih.gov/35661166/. For background of cost/financial toxicity in multiple myeloma.

•• Freed M, Fuglesten Biniek J, Damico A, Neuman T. Medicare Advantage in 2022: premiums, out-of-pocket limits, cost sharing, supplemental benefits, prior authorization, and star ratings. Kaiser Family Foundation website. Aug 25, 2022. Assessed 10 March 2023.https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-premiums-out-of-pocket-limits-cost-sharing-supplemental-benefits-prior-authorization-and-star-ratings/#:~:text=Altogether%2C%20including%20those%20who%20do,(PDP)%20premiums%20in%202022. For understanding the Medicare and Medicare Advantage enrollment, volume of patients insured by Medicare vs. Medicare Advantage, and cost implications to patients and the Medicare trust fund.

•• Cubanski J, Sroczynski N, Neuman T. Medicare Part B drugs: cost implications for beneficiaries in traditional Medicare and Medicare Advantage. Kaiser Family Foundation website. Mar 15, 2022. Assessed 10 March 2023.https://www.kff.org/medicare/issue-brief/medicare-part-b-drugs-cost-implications-for-beneficiaries-in-traditional-medicare-and-medicare-advantage/. For understanding the Medicare and Medicare Advantage enrollment, volume of patients insured by Medicare vs. Medicare Advantage, and cost implications to patients and the Medicare trust fund.

•• (2022) An overview of the Medicare Part D prescription drug benefit. In: KFF. Accessed 5 Feb 2023.https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-prescription-drug-benefit/. This article describes Medicare Part D, which is responsible for the coverage of prescription drugs. This article displays the significant coverage gap that patients encounter, along with the lack of an out-of-pocket spending limit. In this paper specifically, it is useful to display how patients may not have adequate support to afford the significant expense of multiple myeloma treatments.

• Huntington SF, Weiss BM, Vogl DT, Cohen AD, Garfall AL, Mangan PA, Doshi JA, Stadtmauer EA Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol. 2015) Assessed 5 Feb 2023. https://pubmed.ncbi.nlm.nih.gov/26686042/. This article describes the financial burden on those living with multiple myeloma, including treatment costs, hospitalizations, living costs, medical visits, and more. This financial burden negatively impacts patients’ quality of life and can affect clinical outcomes.

•• Cubanski J, Neuman T, Freed M. Explaining the prescription drug provisions in the inflation reduction act. Kaiser Family Foundation website. Jan 24, 2023. Assessed 10 March 2023.https://www.kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act/#:~:text=The%20Inflation%20Reduction%20Act%20amends%20the%20design%20of%20the%20Part,at%20approximately%20%243%2C250%20that%20year. For understanding the Medicare and Medicare Advantage enrollment, volume of patients insured by Medicare vs. Medicare Advantage, and cost implications to patients and the Medicare trust fund.

•• Gibbons JB. Humira: the first $20 billion drug. Am J Manag Care. 2023;29(2):78–80. Assessed 10 March 2023. https://doi.org/10.37765/ajmc.2023.89315. Outlining strategies that manufacturers use to protect their patent and lead to higher costs; probable targets for policy reform.

• Jones GH, Carrier MA, Silver RT, Kantarjian H Strategies that delay or prevent the timely availability of affordable generic drugs in the United States. Blood. 2016;127:1398–1402. Assessed 5 Feb 2023. https://pubmed.ncbi.nlm.nih.gov/26817958/. This article describes strategies that drug companies utilize to prolong the release of affordable, generic drugs into the market in the USA. This includes reformulating a drug with an expanded patent and pay-for-delay patent settlements. These strategies allow cancer drug prices to remain elevated over time.

• IPD Analytics Life-Cycle Insights. IPD Analytics website. 2023. Assessed 10 March 2023. https://ipdanalytics.com. When patents expire and what timeframe generic competition will enter the market to reduce costs.

•• Dickson S, Hernandez I. Drugs likely subject to Medicare negotiation, 2026 to 2028. J Manag Care Spec Pharm. 2023;29(3):229–35. Assessed 25 March 2023. https://www.jmcp.org/doi/10.18553/jmcp.2023.29.3.229?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed. Outlining strategies that manufacturers use to protect their patent and lead to higher costs; probable targets for policy reform.

•• Scheckel CJ, Rajkumar SV. Drug importation: limitations of current proposals and opportunities for improvement. Blood Cancer J. 2021;11(132). Assessed 10 March 2023. https://doi.org/10.1038/s41408-021-00522-3. Outlining strategies that manufacturers use to protect their patent and lead to higher costs; probable targets for policy reform.

• IPD Analytics life-cycle insights. IPD Analytics website. 2023. Assessed 12 February 2023. https://ipdanalytics.com. When patents expire and what timeframe generic competition will enter the market to reduce costs.

•• Medicare Part B spending dashboard. Centers for Medicare and Medicaid Services.Assessed 27 March 2023. https://data.cms.gov/search?keywords=Medicare%20Part%20B%20Spending%20by%20Drug&sort=Relevancy. To demonstrate how much Medicare has spent on accelerated approval agents that were subsequently withdrawn.

•• Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prescription drugs in the United States: origins and prospects for reform. JAMA. 2016;316(8):858–871. Assessed 27 March 2023. https://jamanetwork.com/journals/jama/fullarticle/2545691. Outlining strategies that manufacturers use to protect their patent and lead to higher costs; probable targets for policy reform.

•• Levinson DR. Manufacturer safeguards may not prevent copayment coupon use for part D drugs. Department of Health and Human Services website. September 2014. Assessed 10 March 2023.https://oig.hhs.gov/oei/reports/oei-05-12-00540.pdf. To understand co-pay assistance and grant programs outlining that Medicare patients are exempt from co-pay assistance and grant program funding has stringent criteria and is not guaranteed.

•• Co-pay assistance program. Leukemia & Lymphoma Society website.Accessed 15 March 2023. https://www.lls.org/support-resources/financial-support/co-pay-assistance-program. To understand co-pay assistance and grant programs outlining that Medicare patients are exempt from co-pay assistance and grant program funding has stringent criteria and is not guaranteed.

•• Ouchveridze E, Berger K, Rehman Mohyuddin G. Value in myeloma care: myth or reality. Curr Hematol Malignancy Rep. 2022;(17):206–216. Assessed 27 March 2023. https://link.springer.com/article/10.1007/s11899-022-00669-1. For background of cost/financial toxicity in multiple myeloma.

Wolters Kluwer. Medi-Span Price Rx Pro Online. Database. Assessed February 23. 2023. https://www.wolterskluwer.com/en/solutions/medi-span/price-rx.

Voorhees P, Kaufman J, Laubach J, et al. Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: the GRIFFIN trial. Blood. 2020;136(8):936–945. Assessed March 17, 2023. https://ashpublications.org/blood/article/136/8/936/454474/Daratumumab-lenalidomide-bortezomib-and.

Mookerjee A, Gupta R, Jasrotia S, et al. Bortezomib, lenalidomide, and low-dose dexamethasone (VRD) versus lenalidomide and low-dose dexamethasone (Ld) for newly-diagnosed multiple myeloma- a randomized phase III study. Blood. 2017;130 (supplement 1): 906. Assessed March 17, 2023. https://ashpublications.org/blood/article/130/Supplement%201/906/83569/Bortezomib-Lenalidomide-and-Low-Dose-Dexamethasone.

Kumar S, Jacobus S, Cohen A, et al. Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation (ENDURANCE): a multicenter, open-label, phase 3, randomized, controlled trial. Lancet Oncol. 2020;21(10):1317–1330. Assessed March 17, 2023. https://pubmed.ncbi.nlm.nih.gov/32866432/.

Biran N, Siegel D, Berdeja J, et al. Weekly carfilzomib, lenalidomide, and dexamethasone in relapsed or refractory multiple myeloma: a phase 1b study. Am J Hematol. 2019;94(7):794–802. Assessed March 17, 2023. https://pubmed.ncbi.nlm.nih.gov/31021005/.

Southwest Oncology Group. Comparing combinations of drugs to treat newly diagnosed multiple myeloma (NDMM) when a stem cell transplant is not medically suitable treatment. ClinicalTrials.gov. September 27, 2022. Updated March 2, 2023. Accessed April 4, 2023. Comparing combinations of drugs to treat newly diagnosed multiple myeloma (NDMM) when a stem cell transplant is not a medically suitable treatment - Tabular View - ClinicalTrials.gov.

Facon T, Kumar S, Plesner T, et al. Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. NEJM. 2019;380:2104–2115. Assessed March 17, 2023. https://www.nejm.org/doi/full/10.1056/nejmoa1817249.

Kastritis E, Palladini G, Minnema M, et al. Daratumumab-based treatment for immunoglobulin light-chain amyloidosis. NEJM. 2021;385:46–58. Assessed March 17, 2023. https://www.nejm.org/doi/full/10.1056/NEJMoa2028631.

Yimer H, Melear J, Faber E, et al. Lyra: a phase 2 study of daratumumab (dara) plus cyclophosphamide, bortezomib, and dexamethasone (Cybord) in newly diagnosed and relapsed patients (Pts) with multiple myeloma (MM). Blood. 2018;132(supplement 1):152. Assessed March 17, 2023. https://ashpublications.org/blood/article/132/Supplement%201/152/273100/Lyra-A-Phase-2-Study-of-Daratumumab-Dara-Plus.

Moreau P, Masszi T, Grzasko N, et al. Oral ixazomib, lenalidomide, and dexamethasone for multiple myeloma. NEJM. 2016;374:1621–1634. Assessed March 17, 2023. https://www.nejm.org/doi/full/10.1056/nejmoa1516282.

Shah J, Stadtmauer E, Abonour R, et al. Carfilzomib, pomalidomide, and dexamethasone for relapsed or refractory myeloma. Blood. 2015;126: 2284–2290. Assessed March 17, 2023. https://ashpublications.org/blood/article/126/20/2284/103856/Carfilzomib-pomalidomide-and-dexamethasone-for.

Moreau P, Delimpasi S, Katodritou E, et al. P-206: SELECT trial in progress: an open label, phase 2, study of carfilzomib, pomalidomide, and dexamethasone in patients with first or second relapse of multiple myeloma. Clin Lymphoma Myeloma Leuk. 2021;21(supplement 2):S152. Assessed March 17, 2023. https://www.sciencedirect.com/science/article/pii/S2152265021023338.

McMillan A, Basu S, Karunanithi K, et al. Daratumumab, bortezomib, and dexamethasone (DVd) at first relapse for patients with relapsed/refractory multiple myeloma (RRMM): a UK myeloma research alliance (UK-MRA) real world multicentre analysis. Blood. 2021;138(supplement 1):4120. Assessed March 17, 2023. https://onlinelibrary.wiley.com/doi/10.1111/bjh.18703.

Dimopoulos MA, Quach H, Mateos MV, et al. Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): results from a randomized, multicentre, open-label, phase 3 study. Lancet. 2020;396(10245):186–197. Assessed March 17, 2023. https://www.sciencedirect.com/science/article/pii/S0140673620307340?via%3Dihub.

Chari A, Martinez-Lopez J, Mateos MV, et al. Daratumumab plus carfilzomib and dexamethasone in patients with relapsed or refractory multiple myeloma. Blood. 2019;134(5): 421–431. Assessed March 17, 2023. https://ashpublications.org/blood/article/134/5/421/273899/Daratumumab-plus-carfilzomib-and-dexamethasone-in.

Dimopoulos MA, Terpos E, Boccadoro M, et al. Daratumumab plus pomalidomide and dexamethasone versus pomalidomide and dexamethasone alone in previously treated multiple myeloma (APOLLO): an open-label, randomized, phase 3 trial. Lancet Oncol. 2021;22(6): 801–812. Assessed March 17, 2023. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00128-5/fulltext.

Moreau P, Dimopoulos MA, Mikhael J, et al. Isatuximab, carfilzomib, and dexamethasone in relapsed multiple myeloma (IKEMA): a multicentre, open-label, randomized phase 3 trial. Lancet. 2021;397(10292):2361–2371. Assessed March 17, 2023. https://www.sciencedirect.com/science/article/pii/S0140673621005924?via%3Dihub.

Lonial S, Dimopoulos MA, Palumbo A, et al. Elotuzumab therapy for relapsed or refractory multiple myeloma. NEJM. 2015;373: 621–631. Assessed March 17, 2023. https://www.nejm.org/doi/full/10.1056/nejmoa1505654.

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Paludo J, Mikhael J, LaPlant B, et al. Pomalidomide, bortezomib, and dexamethasone for patients with relapsed lenalidomide-refractory myeloma. Blood. 2017;130(10): 1198–1204. Assessed March 17, 2023. https://ashpublications.org/blood/article/130/10/1198/36368/Pomalidomide-bortezomib-and-dexamethasone-for.

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