Around 24% of patients with ovarian cancer have a germline genetic mutation in homologous recombination repair deficiency (HRD) genes, such as BRCA 1 or 2. Another 26% have a somatic HRD mutation [1,2]. Inhibitors of DNA repair enzyme poly-ADP ribose polymerase (PARP) improve overall and progression-free survival of patients with ovarian cancer and somatic or germline HRD mutations in front-line [[3], [4], [5]] and recurrent maintenance setting [6,7]. The National Comprehensive Cancer Network, Society for Gynecologic Oncology, and American Society for Clinical Oncology recommend universal germline genetic testing at ovarian cancer diagnosis in order to get PARP-I maintenance to patients most likely to benefit [[8], [9], [10], [11]].

However, little is known about utilization of PARP-I in ovarian cancer in real-world practice. First approved by the Federal Drug Administration (FDA) in 2014, PARP-I are expensive brand-name drugs: a year's supply of olaparib is estimated to cost $36,000–$216,000 per patient [12]. Insurance companies may respond to high prescription costs by limiting drug access (i.e., prior authorization), restricting prescribers to one PARP-I (i.e., restrictive formulary), or raising out-of-pocket costs. Studies have estimated 100-fold difference in out-of-pocket costs for PARP-I based on patient insurance [13]. For patients with ovarian cancer, insurance-related delays in initiation or continuation of PARP-I and financial toxicity could impact clinical outcomes [14,15].

Patient perspectives on barriers and facilitators to PARP-I usage have not been studied and provide insight on how to improve clinical care. In other cancers, insurance barriers are associated with significant delays in care and some patients not receiving, or prematurely stopping, highly-effective treatment [16,17]. Our objective was to document patients' experiences of PARP-I and identify patient-perceived barriers and facilitators to PARP-I usage in ovarian cancer.