THE COST OF CANCER TREATMENT

Although the high cost of cancer treatment has been a growing issue in the United States for a number of years, it has recently been focused on in the mainstream media. On October 5, 2014 CBS News 60 Minutes aired an episode featuring correspondent Lesley Stahl interviewing several prominent cancer doctors in the country on this issue of cancer drug costs.  Dr. Leonard Saltz, of Memorial Sloan-Kettering Cancer Center and a member of our Medical Advisory Board (MAB) was featured on the 60 Minutes report. Dr. Saltz said that financial toxicity is a very real side effect of treatment, and Fight Colorectal Cancer agrees.  Patients who have insurance are facing increasing co-pays for these expensive drugs, and in some cases are dealing with drugs that are not covered by their insurance at all.  However, the topic of drug costs isn’t traditionally raised with patients in their doctors’ offices or elsewhere.

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Dr. Saltz: The challenge is knowing where to draw the line between how long a drug extends life and how much it costs. Lesley Stahl: Where is that line? Dr. Leonard Saltz: I don't know where that line is, but we as a society have been unwilling to discuss this topic and, as a result, the only people that are setting the line are the people that are selling the drugs. Read a full transcript of the "The Cost of Cancer Drugs" segment, which aired on Oct. 5, 2014.

A DISCUSSION THAT IS OVERDUE

Fight CRC believes that a discussion about cancer drug pricing is long overdue and needs to take place in forums where patient voices are represented.  We are working with our partners, like the American Society of Clinical Oncology (ASCO) and others who are confronting this issue head-on and we are making sure that a patient voice is at the table in these discussions. In the past, we have been involved with this issue on a case-by-case basis.  For example, as an advocacy organization we actively pressed Sanofi, the manufacturer of ziv-alibercept , and the Centers for Medicare and Medicaid Services on one issue described in the 60 Minutes report.  Although the segment mostly focused on a colorectal cancer drug produced by Sanofi, that is merely one example of an industry-wide issue.  At this point, we believe that the high cost of cancer drugs must be publicly discussed with all stakeholders, including companies, payers, and patients, and that resolution of the problem is critical for the sake of patients.

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UNDERSTANDING THE ISSUE

In 2006, a study  found that more than 60 percent of bankruptcies in the United States are due to high medical bills, and in those cases, three-quarters of those Americans had insurance when they got sick.  Today, the healthcare system is under reform.  But even in light of the Affordable Care Act we must stay vigilant.   It is undeniable that  drug pricing and health care coverage reform is necessary to ensure the best interests of patients and as a society we must expand our vocabulary to include financial toxicity as a real problem that patients face as a result of a cancer diagnosis. On March 24, 2008, NBC News reported: The idea: treat cost essentially as another side effect to weigh in choosing a therapy. Dr. Neal J. Meropol has watched patients do those calculations on their own, like the colon cancer patient who asked to switch from oral chemo to cheaper but more laborious intravenous chemo, or the woman who refused a pricey anti-nausea drug that would make her chemo more bearable. "Even if doctors want to discuss cost, they may not know it  — it’s not included in treatment standards," said Saltz.  At a meeting of the standard-setting National Comprehensive Care Network earlier this month, Sloan-Kettering’s Saltz and other doctors urged adding chemo prices to those treatment guidelines.

“If there’s a need to spend it, let’s talk about it. If we can do it just as well less expensively, I think doctors should know that and be able to make a decision,” Saltz says.

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In March 2010, the journal The Oncologist published the report Drug Pricing and Value in Oncology , by Patricia M. Danzon, Ph.D. of the Health Care Management Department at The Wharton School-University of Pennsylvania.  She succinctly summarized this very complex drug pricing issue:

High prices for cancer drugs are a growing concern to payers and patients, given the large number of cancer drugs in development. Although new drugs may offer health benefits, their high prices raise questions of crowd-out of other services in payer budgets, affordability of copayments to patients, and concern whether the health benefits gained warrant the high cost. These concerns reflect the broader challenge of assuring value for money in health care, which is less constrained by market forces than are other sectors of the economy. For most goods and services, we rely on standard competitive markets to align prices with value to consumers and costs to producers. If consumers are reasonably well informed and spending their own money, the prices they are willing to pay reflect their valuation, and consumer price sensitivity also constrains manufacturers to charge prices that approximate costs, provided competitive alternatives are available. Thus, in well-functioning markets the “invisible hand” of the price system aligns value to consumers with cost to producers and hence assures that resources are allocated to yield maximum value. However, health care markets in general and pharmaceutical markets in particular function less well to align value, price, and cost, because necessary conditions are weaker. Patients, payers, and even physicians often lack good information about effectiveness and risks, especially for new drugs. Patents and other market exclusivities limit competition in order to preserve incentives for research and development (R&D), but thereby also reduce competitive pressures on prices. Most important, insurance drives a wedge between the out-of-pocket prices consumers pay and the prices manufacturers receive, with the difference paid by insurance. Danzon concluded that, "Efficiency in drug pricing and resource use for cancer could be enhanced by changes in our insurance and reimbursement systems, including reporting of outcomes-adjusted prices to enable physicians, patients, and payers to make more informed choices."

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OUR ROLE

Fight Colorectal Cancer is playing an important role in engaging and monitoring relevant policy implications for patients.  We have been and continue to be at the table with pharmaceutical companies, payers, and government agencies. We applaud the 60 Minutes report for its coverage and the efforts of physicians, insurers, and policy makers to decrease the cost of healthcare.  At the same time, it is important to note that our efforts to reduce cost should not impact the ability of patients and their physicians to make important decisions based on the needs of individual patients.  Cost is one factor in decision-making; however, it should not be the deciding factor. Our issue brief on clinical pathways and guidance on our position for insurance companies lays out our position on guidelines designed to help contain costs.  We believe that transparency and the best interest of patients is key when reducing healthcare costs. It is important to note here that the high costs of the drugs causes everyone’s insurance premiums to be higher.  The problem is not just the co-pay. The co-pay is a symptom of the high costs.  To address this complicated issue, we must commit to a continued dialogue on the price of cancer care and push pharmaceutical companies, clinicians, payers, patients and policy makers to openly discuss this issue. As an organization, we continue to underscore the need for transparency because we fundamentally believe having an informed choice allows patients the opportunity to make sound decisions about their life and treatment.  We know that patients are carefully evaluating their options and cost of care is a factor being considered when making treatment decisions. As a community, we need to be a part of defining the line. We will continue to engage in this issue, and will keep you posted on progress. To learn more about our advocacy efforts and the coalitions working on this issue click here.

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Be an advocate - Join us!  Sign up for our Patient Resource Facebook Page Get the latest Fight CRC updates Disclosure: Fight Colorectal Cancer has received funding from pharmaceutical companies in the form of unrestricted educational grants. We maintain ultimate authority over website content and the content written in this article. Read Biotechnology Industry Organization's (BIO) response to the 60 Minute interview here.