What are alternative myeloma therapies for patients who are unable to afford lenalidomide or oral cyclophosphamide due to gaps in prescription drug coverage?

Unfortunately, this is a big problem, especially in community centers where the resources for grant applications are scarce. At bigger institutions, like ours, we have a dedicated person who searches for all possible grants. If unable to, then the pharma companies have been generous to give free drugs- BMS especially.

For cytoxan, yes, copay can be very high for Medicare patients. I tend to give cytoxan IV for many of our Medicare patients.

So regimens that can be given in the clinic/infusion if oral meds are not an option:

• Daratumumab/velcade/cytoxan (IV, same dose as you would PO)/dex - I use this combination the most in these cases
• Daratumaba/cytoxan/dex
• Carfilzomib/cytoxan/dex
• Velcade/cytoxan/dex
• Dara or isatiximab/carfilzomib/dex

Any...