How Much Do Cancer Drugs Cost?

The line from the pharmaceutical manufacturers have always been that it costs billions to develop new drugs. And they have to recoup their costs for the drugs that don't make it. This is why we have cancer treatments that cost well over $100,000 each year.

But now the truth is out.

Tufts Center for the Study of Drug Development conducted a study on development costs of cancer drugs.What they found is a much lower total for development of a cancer drug.

"A new analysis finds the magic number is $648 million, which is substantially less than an earlier albeit controversial estimate of $2.6 billion for the cost to develop any and all new medicines, in general. 

As with that earlier estimate by the Tufts Center for the Study of Drug Development, though, this latest analysis is already engendering criticism, a reflection of an ongoing debate over true development costs and how these should be calculated. This is important because the pharmaceutical industry has often used R&D costs to justify its pricing."

“These results suggest that pharmaceutical drug development is extremely lucrative and the current drug prices are not necessarily justified by the R&D spending on these drugs,’’ the researchers who conducted the new analysis — Dr. Vinay Prasad of Oregon Health and Science University and Dr. Sham Mailankody of Memorial Sloan Kettering Cancer Center — wrote in JAMA Internal Medicine. 

To arrive at their $648 million estimate, the researchers chose 10 publicly traded drug makers with only one cancer medicine that, at the time of regulatory approval, had no other treatments on the market. They reviewed eligible candidates during a 10-year period beginning in January 2006, some of which were developed internally and others that were acquired. 

They calculated total R&D spending from the first R&D work to the year of approval and also accounted for failures — the cost of drugs that never made it to market. In addition, the researchers assigned 7 percent opportunity costs, which is the return that investors could be expected to forgo if the money had been invested elsewhere while a drug is being developed. This raised median costs to $757 million. 

“The total revenues from the sales of these 10 drugs after approval were $67 billion, more than 7-fold higher than the total R&D spending,’’ Prasad wrote in an e-mail. “The median time on the market for these drugs was four years. Since the median duration of market exclusivity for oncologic drugs is about 14 years, these drugs will earn billions more. Nine out of 10 companies had higher revenues than R&D spending and four companies had more than 10-fold higher revenues than spending.’’ He also maintained that the cost to develop cancer medicines is unrelated to the novelty of the mechanism of action or the efficacy of the drugs. "

Of course there are dissenters to this study's results as always. Personally I believe any study will have its dissenters. It is not that difficult to find something to disagree with on any topic.

But I digress. Although this number may seem astonishingly low compared to the previously cited $2.6 billion, I still think that the truth is much closer to this latest number of $648 million than to $2.6 billion. This latest study, while under scrutiny is probably a new

Back to Breast Cancer Stuff

(So my plan is coming together and my life goes back to reflecting on breast cancer crap.)

Earlier this week, the FDA approved a new medication to be used with Letrozole (Femara) or other aromatase inhibitors for hormone positive metastatic breast cancer patients. This medication (which I can't pronounce and just think of it as the 'kis...') is called Kisqali (chemical name: ribociclib). It works similar to Ibrance... Not that that means much to me but as a reference.

My real concern is the cost. Ibrance costs $9850/month for treatment. Not cheap. All new cancer treatments seem to cost so much. 

But I am pleased to learn that Novartis has developed a flexible pricing plan for Kisqali;

"The med—a first-line treatment for HR-positive, HER2-negative breast cancer that will compete with Pfizer’s Ibrance—will roll out as early as Tuesday under a flexible pricing structure, the company said on a conference call following Monday's FDA approval. A 28-day supply of the 600-mg dose will cost $10,950, while the same supply of the 400-mg dose will go for $8,760 and the 200-mg dose will run at $4,380."

My hope is that now there will be some price competition between the two. Not that many stage IV cancer patients do much price shopping while looking for treatment but maybe the insurance companies will.

However, the best thing is that more cancer drugs are being developed and are finally hitting the market. 

Reducing Cancer Care Costs and Hospital Stays

There are two really irritating things about cancer care for me. (Well there are really lots of things that irritate me about cancer care. I could make a giant list of them if anyone really cared but today I am going to focus on two things.

Cancer care is ridiculously expensive. You can take a drug for $100,000 that might increase your lifespan for a couple of months. A single chemo infusion can cost upwards of $20,000.

And at the least sign of germs or low blood counts, you are sent to the emergency room where they admit you. That is a really stupid part. You feel like crap on a Friday night, you call your oncologist and they send you to the emergency room for blood tests and then they admit you after you sit in a room full of car accident victims and finally end up in a really uncomfortable bed with IV antibiotics. Really not a good idea.

The second annoying issue is how quickly doctors throw more drugs at cancer patients. Here, take this too and this and this and this. Let's get you some skilled nurses at home to help you with some fancy new equipment. Each one adds another triple zero item to your bills.

(I could rant on about the annoying part of going to daily radiation for weeks and weeks.)

But finally there are two new ideas that are focused on reducing cancer care costs and hospital stays. (Its about time.) Anyway here are the two new ideas:

Oncologist Dr Barbara McAneny in Albuquerque, NM looked at how her cancer patients dealt with hospital stays and ER visits due to low blood counts and other chemo side effects. She convinced the rest of her practice to provide weekend and evening availability for shots. Then they added other 'off hour' services such as nighttime appointments and same day availability. This resulted in major cost savings and reduced hospital stays. This practice is now being expanded to other clinics across country.

Next, this program above has been expanded even more after July 1 of this year:

"The Centers for Medicare and Medicaid Services has long talked about alternative payment models (APM), and now they are a reality: as of July 1, CMS launched its first APM, for one of the priciest specialties in healthcare, oncology.

The so-called Oncology Care Model (OCM) is now in play in 195 practices across the country, and will last 5 years. Late last June, just before the OCM went live, CMS Acting Administrator Andy Slavitt tweeted: "Big news fr @CMSGov this morning. 3,200 oncologists (double the target) signed up 4 new payment model -- 25% of all cancer care smarter way."

In a nutshell, in addition to traditional E&M codes, the CMS is paying oncologists $160 a month per patient undergoing chemotherapy for 6 months, starting with the patient's first dose. Oncologists are supposed to use that money to set up programs that effectively manage patients' chemotherapy complications "and heighten the focus on furnishing services that specifically improve the patient experience or health outcomes," the agency said.

A key element is that practices must provide "patient access 24 hours a day, 7 days a week to an appropriate clinician who has real-time access to practice's medical records." This and some other aspects of the OCM were drawn from the "Come Home" program pioneered in Albuquerque, N.M., by oncologist Barbara McAneny, MD."

Okay, who wnts 24 hour access, 7 days a week during cancer treatment? Me! Look at smart business practices being applied to cancer patients, reducing care costs and hospital stays.

$107 Billion on Cancer Drugs

I did not make up that number. That is how much was spent on cancer drugs world wide last year. Is it really worth it? Does it sound normal to take a drug that costs $10,000 per month? And that $107 billion reflects a 11.5% surge from new drugs introduced last year.

A recent study was done for the National Institute for Health revealed a lot of questions, not a lot of answers. And the real question is are cancer patients getting their money's worth. The main goal of any cancer drug should be a longer life - which would be a cure. Correct me if I am wrong, but that is how I see it. Why else would we want these drugs? Its nice when they reduce pain and make us feel better as well but we really hope that we will live longer.

"The report from IMS Institute for Healthcare Informatics highlights 70 new cancer treatments, treating more than 20 types of tumors, all approved in the past five years. In the United States, where cancer drug spending was $37.8 billion last year, those new drugs alone account for $9.4 billion of the increase since 2010.""

"... Not all approved cancer drugs are alike. Some may provide profound benefits, lengthening life by years; others may significantly shrink a tumor, but increase patients' chances of survival only by small amounts.

Prasad's work has found that the high prices of new cancer drugs don't reliably reflect their novelty or how well they worked in trials. One of his studies, published last year in JAMA Internal Medicine, examined 36 drugs that were approved between 2008 and 2012 based on early indicators that they were working, such as evidence that they shrank tumors. Such measures are meant to speed up drug approvals, but there's no guarantee that a drug that temporarily stops a tumor from growing will extend lives. Only five of the 36 drugs in his study lengthened patients' lives, despite a median of more than four years of follow-up study."

So why are we spending all this money if most of them don't make us live longer? That's not worth $107 billion.

Breast Cancer: At What Cost?

Even with insurance the cost of any ailment, not matter how large or small, can be formidable. For some people the $20 co-pay to see the doctor can be a dent in their wallet. And new research shows that even with insurance, depending on coverage, state of disease at diagnosis, treatment required, and many other variables, medical bills can range between $20,000 and $100,000.
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I know that even with my health insurance, which is pretty darn good, we spent thousands of dollars on my health right after diagnosis. And with my oh-so-healthy-body, we continue to spend thousands. And you can subtract any potential salary I might have - because I can no longer work.

Going back to work after breast cancer can take a few years. I know many women who do not return to work full time because they do not feel physically or emotionally up to it. Even if there is a financial need.

Breast, or other type, cancer diagnosis, knocks your socks off. You may never regroup. You certainly never go back to your old self (just that fictitious new normal). And that you forked out up to $100,000 just to get to that new 'normal', your wallet (and retirement) won't be the same.

You can go to doctors and medical professionals to heal physically. You can go to support group and therapists to help mentally. But financially you are never the same, no matter how rich or poor you were to stop.

More on cancer costs

A few days ago, I blogged about the costs of cancer. But there are lots more costs of cancer that are not just financial.

There are physical costs that include surgical scars, damage to your body from treatments, and more.
The emotional costs are things like PTSD which takes a lot to get through. Neither of these can ever really go away. You just end up covered in scars inside and out.

So well-intentioned people do things like give free trips and events for those who were diagnosed with cancer. These are the people who offer trips to us cancer people.

If you have been diagnosed with cancer, you can go to events like the Stowe Weekend of Hope for free the first year. Then you get an incredibly discounted rate for future years. Don't get me wrong, the Stowe Weekend of Hope is a wonderful event with so many resources for those with cancer. But I just wish I didn't have the medical history which allows me to go so cheaply.

So as we dig deep in our financial pockets we also have to cope with all the other costs and you can't just declare bankruptcy and walk away from your emotional and physical costs.

The Costs of Cancer

So you get diagnosed with cancer and all of a sudden you put your entire life on hold and you grapple with side effects, hair loss, constant aches and pains, surgical recovery, and giant medical bills. You rob Peter to pay Paul so to speak every month as you juggle your bills. You take time off work to cope with treatment and your income tanks and money is even tighter. You try to save for retirement as you wonder if you will be there for retirement.

But picture this if you were in college or just out and didn't really have a job. You are dependent on your parents for money. You alternate between your dorm room, your parent's sofa, and the infusion room. You try to figure out how you are ever going to have a career, if you are going to have a career. You hope you do not have to declare bankruptcy before 30 just to stay solvent because you have student loans and medical bills. At the same time you wonder if you will be around to turn 30.

I have been in both situations. At 19, I was diagnosed with thyroid cancer, but was still on my parent's health insurance and it took a summer to deal with the bulk of treatment, but have had follow up's every year or more often since. Medical bills and student loans were not as sky high back then but I did go through a lot of angst as a result of my diagnosis.

Then at 45 I was diagnosed with breast cancer and wondered how to pay bills as I job hunted through treatment. I haven't worked full time since. Money is much tighter now. Saving for retirement has been less important. With two cancer diagnoses, retirement looks a bit iffy at times.

At some point I learned about a wonderful organization called The Samfund. This group helps those young adult cancer patients figure out their financials and provides some grants. How do they know how to do this? The founder has been through this herself. I just wish they were around for me decades ago.

Being told you are cancer free only makes you find out about all the costs you still have to pay - financial, emotional, and physical.

Cancer Drug Costs

These prices are out of control. Upwards of $80,000 per patient per year or treatment protocol. Yes insurance companies pay the bulk of the costs but patients are hit with 20-30% out of pocket co-payments. Since the average family income in the US is $52,000, how are we supposed to pay for this? Can you only beat cancer if you are rich? That really creates a chasm between the 'haves' and 'have nots'. And the current insurance system cannot afford them either.

There is a new call by a group of doctors, oncologists, to get a better control of the pricing set by the drug manufacturers. This was announced in a recent issue of Proceedings published by the Mayo Clinic. It was also written about in Time Magazine and there is a petition on Change.org.

They offer a substantive set of arguments for the pricing changes that are definitely worth the read. They also discuss the high costs of developing drugs that are borne by the manufacturers and how that should be changed as well. They are not just firing at the drug manufacturers but providing multiple recommendations:

"Among the recommendations are allowing Medicare to negotiate prices, permitting cancer drug imports for individual patients, and passing laws to keep drug companies from delaying access to generic drugs."

My only complaint on this issue is that they focus on cancer drugs and not on the other high priced drugs out there. In my opinion, the changes should effect all drugs.

Please go read the articles and sign the petition.

Doctors are factoring in costs too

Last week, I blogged about insurance companies wanting their money back if one of the expensive drugs don't work. Now oncologists are going to start tracking the effects, side effects, and costs of the expensive cancer drugs.

In recent years, I have had doctors suggest drugs to me and also comment on their costs. In previous years, I do not remember hearing about costs. And they are now quick to pass along any savings cards available from the manufacturers.

"Alarmed by the rapid escalation in the prices of cancer drugs, the nation’s leading oncology society unveiled Monday a new way for doctors and patients to evaluate different treatments — one that pointedly includes a medicine’s cost as well as its effectiveness and side effects.

The American Society of Clinical Oncology’s “value framework” is part of a change in thinking among doctors, who once largely chose drugs based on medical attributes alone. The major cardiology societies, for instance, are also starting to factor cost into their evaluations of drugs."

It is definitely the time to do this. Drugs that cost north of $10,000 per month are cost prohibitive for many, especially financially strained cancer patients. And drug companies do not seem to care about that. They care about their bottom line and how much they can charge.

So now if insurance companies and doctors are going to start pushing back on the drugs, maybe they will listen.

Money worries during cancer and other illnesses

First there is the whammy of you have cancer, followed by many more whammies including hair loss, surgeries, chemotherapy, and then finally money. You cut back on work during treatment and the bills get bigger. And cancer bills aren't little. A chemo infusion or surgery might hit 5 digits for each one. Your insurance covers some of it but there is always your portion. And the bills keep coming.

Barbara, over at Let Life Happen blogged about an interesting option on how to fix cancer costs by charging by patient instead of by each treatment. Cure Magazine recently ran an article on medical bankruptcy fears during cancer. (And if you have cancer and don't read Cure Magazine, you are missing out big time.)

Cancer is stressful enough without having to worry about money as well. I personally think that if you get cancer, you deserve a financial fairy godmother to swoop in and take care of you during treatment. You shouldn't have to worry about bills, cleaning your house, doing laundry, taking the car to the garage, or standing in line anywhere. That would be nice - but really not likely.

So if we aren't going to get financial fairy godmothers, I think we need to start focusing on changing the medical system to help reduce the financial worries when diagnosed with any major illness. Doesn't it seem illogical that the sickest people get the biggest bills? They are most likely not to be able to work full time and earn the big bucks. They get all the expenses and are least able to pay.

I have a friend with MS who used to have a great career. Now she writes articles for a local paper and lives on social security. I used to work full time and now I struggle with 15 hours a week with RA and fibromyalgia. And I get giant medical bills. This year so far, I have already hit $2500 in copays. And its only April.

Let's fix the system and stop causing medical bankruptcies.

And the costs just keep piling up

Back at my first cancer adventure in 1981, my father advised me never to let my Blue Cross health insurance lapse because going forward with a pre-existing condition, I could always lose my health insurance. And that was something I could not afford. For quite a few years, until MA changed the law regarding pre-existing conditions, I would often pay for my own private health insurance to ensure I never lost Blue Cross. Even if my employer was offering another plan, I would pay for my own. That wasn't cheap.

Then I had more medical adventures and got to know the surgery department and ER a few more times. I kept my Blue Cross insurance and kept on paying. From time to time I would have a job which offered Blue Cross insurance. Then the law changed and I could stop that.

In the past 7 years since my second cancer adventure, I average a minimum of 50 doctor appointments each year. We max out our out of pocket coverage each year as well. One year a friend convinced to try to keep track of what insurance paid vs what I paid. No contest. I paid a tiny portion of the hundreds of thousands paid by the insurer.

So I am verification of a new study showing that after cancer, patients face rising costs of health care. All of a sudden you get more doctors and more appointments and everything needs to be checked because of your medical history, blah, blah, blah. And there are all the health issues caused by side effects of treatment that may never go away. The lost productivity costs because you have to go to the (damn) doctor or don't feel well enough to work that day. The list goes on.

But now it looks like a cancer diagnosis is financially as well as emotionally and physically taxing.

Going for the heart strings, of course

There was a new study (because we need a new study so the researchers don't have to polish up their CVs -  that's resume for the non-technical) that says there are more and more ads for cancer treatments and cancer treatment centers. Their results showed that:

"A systematic content analysis of these ads found that the content is sharply directed at a would-be patient’s heartstrings:

  – 85% made emotional appeals to consumers
  – 61% used language about hope, extension of life, or a cure
  – 52% touted innovative, or advanced technology or treatments
  – 30% evoked fear by mentioned death, fear, or loss

Nearly half of the advertisements included patient testimonials, but only 15% included a disclaimer about patient outcome. No advertisements described the outcomes a “typical” patient may experience. Failure to disclose this information is a violation of a Federal Trade Commission mandate, the report notes."

Only 2% of the ads disclosed the risks and 5% disclosed the costs. Basically, they skipped right over the parts that say you might be throwing up as you are going bankrupt... but I digress.

Emotion based advertising is a key target in the advertising world. Feel their pain and you can make them open their wallets. But evoking fear of death is kind of creepy. If you don't try this, you WILL die!

"“Clinical advertisements that use emotional appeal uncoupled with information about indications, benefits, risks, or alternatives may lead patients to pursue care that is either unnecessary or unsupported by scientific evidence.”"

The researchers conclude by saying that further research is needed to see if this emotion based, direct to consumer advertising is contributing to the sky rocketing cancer care costs in recent years. (Job security.)  If it is promoting misinformation by omission of key information for consumers and playing on their emotions, its not a great use of the money.

My thought is all this advertising is clearly contributing to pharmaceutical company and medical center bottom lines through additional costs. Which in turn is bumping up their overhead. The kind of advertising that is done is not cheap. So maybe we should just get rid of it - just as we got rid of alcohol and tobacco advertising in the past and their costs would go down, and then our prices. But that would be a pipe dream on our part.

How much would you pay to heal yourself?

Current pharmaceutical pricing of new cancer drugs are sky rocketing. $100,000 for a new medication designed to extend life by months or weeks is crazy. Here is a very long article on cancer drug pricing and all the issues surrounding it. I say read it, its worth it to get a better understanding of the issues surrounding the high prices.

My few points are:

• Pharma companies spend billions on research, required testing to meet FDA standards, and then can only expect to reap the benefits through the length of their patent which is ten years.
• If they lowered prices, their share holders would be unhappy and less likely to fund additional research for new drugs which would result in fewer new drugs in the future even though the short term benefit of reduced pricing would benefit patients. But the shareholders would be happy.
• In their research process, numerous discoveries do not make it FDA approval and are tossed, throwing out years of research and billions of lost costs.
• And the most appalling: "The high cost of current cancer therapies is at least limited by the relatively small patient populations they treat.  Next generation immunotherapies, including CTLA-4, PD-1 (programmed cell death), and chimeric antigen receptor therapies (CARTs), appear to deliver much improved outcomes (in some cases including complete remissions) with limited side effects – and may also be used to treat many more cancer types and much larger patient populations than current therapies.  Given their inherent value to patients, they could easily command prices well in excess of $100,000 per course of treatment." Please reread that last sentence: Given their inherent value to patients, they could easily command prices well in excess of $100,000 per course of treatment.

I can accept that lots of research can end up in the trash bin if drugs do not perform as expected. I can buy that happy, rich, healthy share holders help companies stay on track. But I cannot and will not accept pricing based on the 'inherent value to patients'. That is basically saying that they are charging what they think a patient would pay.

This is like saying when you break a leg, how much would you pay to have it set and mending with pain under control? At the second of pain, you would probably pay $2000 for that first shot of morphine....

That's insane. Go get some morals and charge patients correctly.

The Cost of Cancer Care - or Big Pharma Is Getting Rich

Today's Boston Globe has an article on the "Sky-high drug prices test cancer patients". A few little pieces of information I drew from it:

"In the United States, a month’s supply of a brand-name cancer drug is now about $10,000, double what it was a decade ago, according to the report. The most expensive drug, at $117,648 for a course of treatment, is Bristol-Myers Squibb Co.’s Yervoy, the first drug to prolong survival in patients in advanced stages of the skin cancer melanoma...."

"...On average, an insured patient’s total outlay for a year’s cancer treatment is about $9,000, excluding any assistance programs, with the insurance company covering the remaining $115,000, according to Aitken. Patients receiving older cancer drugs available as generics would pay less.

The higher the patients’ costs, the more likely they are to drop out of treatment before finishing. For example, the report notes that when copayments for hormonal breast cancer treatment exceed $30, there is a 10 percentage point drop in the number of patients who complete therapy, compared with when the copay is $30 or less. For patients who stop therapy and resume it later, the combined patient and insurer costs can jump 50 percent."

$9000 per year is not chump change and the insurance company's share is a paltry $115,000 - so you wonder why insurance companies are feeling the crunch.

But then I found a little article on Pfizer and how generics are hurting Pfizer's profits:

"Despite sharply lower expenses and taxes, Pfizer Inc.’s first-quarter profit dropped 15 percent, due to generic rivals and an end to some promotion efforts with other drug makers. Shares fell as the company missed revenue expectations by $730 million, but narrowly beat profit estimates. Revenue at the New York giant has fallen since 2011 as cheap generics hurt sales of some off-patent drugs that once brought in billions annually, particularly the cholesterol fighter Lipitor, the top-selling drug ever, with peak revenue of nearly $13 billion."

But before you feel sorry for Pfizer at all, their reported net income for the first quarter of 2014 was $2,329,000,000 on $11,353,000,000 reported sales.

So I dug a little more on Pfizer and found this lovely section on the Value of Medicines for Oncology in their Press Kits and Downloads. So I started reading after many self accolades on their benefit to society and was appalled by this section on page 2:

"Based on the average cancer drug expenditure per patient from diagnosis until death over the past decade, an analysis showed that the cost of that added year of life – plus any further benefits to the individual’s quality of living – was about $6,500. Given that surveys indicate that most Americans would be willing to pay $100–$300 thousand to extend their lives by one year, $6,500 represents a bargain for society.
 
For decades, the U.S. public and private sectors have committed substantial resources toward cancer research, but the societal payoff has not been well-understood. One study estimated between 1988 and 2000, life expectancy for cancer patients increased by roughly four years, and the average willingness-to-pay for these survival gains was roughly $322,000. Improvements in cancer survival during this period created 23 million additional life-years and roughly $1.9 trillion of additional social value. The share of value flowing to patients has been rising over time. In terms of economic rates of return, R&D investments against cancer have been a success, particularly from the patient’s point of view."

So they are justifying their high prices of cancer drugs based on the fact that most Americans would be willing to pay huge sums to extend their lives by one year. A bargain for society? So they are getting rich on our wishes not to die? Please. I have no sympathy.

Oral Parity or Time to Write Your Congressman

Does anyone know what that means? When I first  heard it, I needed an explanation. Oral means something to do with your mouth. Parity is something about evenness or equality (I am so smart I came up with that myself).

So what is oral parity? Its about health insurance paying for oral medications the same way they pay for in hospital infusions and other medical treatments.

You get the basics. You go to the doctor and get an IV or a shot and you pay a copay and go home. Or you go pick up your prescription and if you are lucky its a generic and costs somewhere less than $20.

But if its a brand name drug with no generic available or a new brand name drug which is considered to be a premium or Tier 37.8 (or whatever term the insurance company wants to call it to make you understand its EXPENSIVE). That means your co-pay will be something that puts a significant dent in your wallet. My copays max out at 35% of the cost. I have gotten the $100+/month prescriptions and am on one now. If I go through mail order, its a paltry $95 per month.

I think I have blogged about this before but it is increasing in importance. Currently 1/4 of all cancer drugs in development are planned as oral medications. So if a new cancer drug costs $100,000 per year and a patient needs to pay 35% of that? You can do the math.

The results is doctors are less likely to prescribe the expensive oral drugs or patients go bankrupt or just don't fill their prescriptions. To get affordable cancer care, a patient needs to get an IV infusion which is stressful, time consuming, and probably not the most advanced treatment available.

For the third time, a bill is going through Congress:

"The Cancer Drug Coverage Parity Act of 2013 (HR 1801) seeks to amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 "to require group and individual health insurance coverage and group health plans to provide for coverage of oral anticancer drugs on terms no less favorable than the coverage provided for anticancer medications administered by a health care provider." Companion legislation must be introduced and passed in the Senate before the bill can become law."

You know how agreeable Congress is these days. Maybe its time to write your Congressman/woman.

The Cost of Cancer Care, Part 3

The next topic I will cover is controlling costs in cancer care based on the next article availabe from CancerNetwork.com. Here's a little factoid:

"Cancer patients under active treatment comprise 1% of a payer’s patients but as much as 10% of costs."

Or 'Ouch!'.

Cancer care is expensive. How can the costs be controlled by still providing the patients with the optimal level of care in what is largely still a guessing game? Initial chemotherapy doses are often based on body weight. Then if a patient reacts, the doses can be adjusted down. If one treatmetn doesn't work or has adverse results, then a new treatment is tried. All of which may be very expensive.

Here's a 'brilliant' idea. Have physicians take cost into consideration when prescribing treatment. Well whoop de doo. What about the patient who is the center of all this? They should be the primary consideration.

So then why is cost a consideration? Because costs of treatment are too high and insurance companies are dictating treatment based on their perception of need vs. costs.

"Care for oncology patients, particularly in the adjuvant setting, is often given over predictable time frames. Instead of paying for each element of care separately, episode-of-care payments either can either pay a flat fee per unit of time or a flat fee for a defined care plan. The availability of accepted guidelines in oncology facilitates this payment approach.

Bach et al proposed such a model for metastatic lung cancer.[9] In this model, oncologists would receive a monthly payment derived from the average cost of caring for all patients with metastatic lung cancer. This payment would bundle the costs of chemotherapy, supportive care medications, and administration. Medicare payments would then be adjusted over time based on claims submitted during prior episodes. Physicians would have to demonstrate that treatment conformed to an accepted standard of care. The intent of the program would be to achieve savings by making physicians discretionary purchasers based on price. The downstream effect would also pressure pharmaceutical manufacturers to adjust drug prices downward in order to be economical within the structure of the payment model."

The crux of the problem is cost is so out of proportion to other medical costs that it must be considered for cancer patients. The problem though is the patient's life can depend on the chosen treatment.  I like the end result noted above that pharmaceutical manufacturers would need to adjust their pricing. Which is the real goal -  make the treatments less expensive - particularly in the US where patients unevenly absorb the research costs that are less frequently distributed to overseas patients.

Another model being reviewed is the Oncology Model Home:

"The medical home model of oncology care is another critical opportunity in the evolving delivery of oncology care, to both ensure quality and reduce cost.[12] The model emphasizes improved care coordination, recognizing that fragmented care acts as an important cost driver in oncology. This model began with the efforts of Dr. John Sprandio with Consultants in Medical Oncology and Hematology, the first oncology practice to achieve level III recognition from the National Committee for Quality Assurance.

The model employs several elements, with its key strength being its synthesis of multiple separate but important efforts in oncology: care coordination, open access, quality measurement, guideline adherence, and cost savings by preventing emergency department (ED) visits and hospitalization. Patient performance status is a key metric for decision-making, including eligibility for chemotherapy administration. This helps to ensure that patients are appropriate for active treatment vs palliative care. Dr. Sprandio’s practice has achieved reductions in ED visits per chemotherapy patient by 68% and hospitalizations per chemotherapy patient by 51%.[13] These are meaningful accomplishments, since the cost of hospitalization may equal or exceed spending on oncology drugs."

I like this idea better. Coordinating care with patient performance as a significant part of the decision making process. This makes the  patient the centerpiece as they should be.

Cost containment should never include rationing of care or so called 'death panels' as they are not humane options. In my mind the two issues are costs of care and the patients treatment/quality of life. Any other suggestions are welcome.

The Cost of Cancer Care, Part 2

Cost is now becoming a significant factor in people's cancer treatment decisions - something that should not be happening.

In the past decades, and more significantly in recent years, there have been many developments in cancer treatment. We hear talk about individualized medicine, new treatments which add months to stage IV cancer patients' lives, and more. But we rarely or never hear about the costs. I think of it as the silent side of treatment.

Often these new treatments costs tens of thousands of dollars or more for a single year of treatment with a single dose coming in at the multi-thousand level. What is wrong with this picture? Lots. Why should a patient make a decision on their life because their cancer treatment which could extend their life is out of their price range? Please do not suggest the patients ask for assistance from the pharmaceutical companies because that is not always available.

See this example from an article on CancerNetwork.com, titled "The Cost of Cancer Care, Part I":

"Three years ago, I counseled a patient after a gastrointestinal stromal tumor had been resected from his stomach. I was pleased to be able to tell him that imatinib (Drug information on imatinib) (Gleevec), a drug very well tolerated by most patients, would meaningfully reduce his risk of recurrence. Later, we learned that his out-of-pocket expense under his Medicare Part D plan would be several thousands of dollars for a year of treatment. The patient decided the expense was too onerous and that he would forgo treatment. Patient assistance programs are often limited for Medicare beneficiaries, and none could be secured. I pressed to ascertain whether cost was his sole concern, or if there was another unspoken reason for his resistance to proceed with treatment. There was not; his decision was purely due to cost."

There have been many significant advances in cancer research in recent years including a greater understanding of the biologic side of the disease. The research and FDA approvals can take over a decade to complete. Companies are then offered patent protection for 17 years (or something close to that as my chemo brain fails to recall the exact number) to protect their pricing from competition. Costs in research have escalated creating high drug costs. Other contributing factors are:

The ensuing problem is that costs are high for the patients, insurance companies have high copayments for new non-generic/non-preferred medications. There is a switch to oral treatments which are covered by pharmacy benefits. A chemotherapy infusion may be covered by a $50 copay but an oral chemo in pill form might have a several thousand dollar copay.  Its easier on the patient than going to the hospital but much tougher on their wallet. But research has helped saved many lives. There are more gains visible in the coming years as well but at what price?

"These gains have not come without a price. Research and development is expensive. Patients who survive longer under active therapy generally receive more intense overall treatment; this includes not just the therapy itself but also the radiographic and laboratory surveillance necessary to monitor ongoing treatment response and toxicity. While we strive for the development of more effective, less toxic therapies, this progress may be transforming into a painful paradox: the more we advance scientifically, the more constrained we become economically."

So how do we progress and allow advanced treatments, longer lives, and containable costs? That will be part of my next post.

[This is something new for me to have a series looking at a particular issue. As my personal cancer story becomes more of a maintenance factor and a new lifestyle with my other newer ailments, you may see more of these posts in series on differing topics but always ailment related.]

The cost of cancer care

New drugs are developed which offer hope to many with late stage cancers. You can't really put a price on a human life and some how I think that drug manufacturers know this so they have no problems charging these outrageous prices. One was $120,000 for FOUR doses. Another is $10,000 per month. A third is $80,000/year.

If you are in a clinical trial you get the drugs free. So obviously they can afford to give them away. So if you are paying are you paying for the free ones that went to other people and for all the research costs? I wonder what these cost outside the US. There should be some kind of global pricing standard for medications.

And then for these drugs a success rate of 40-50% is considered good. It means the patients are still alive.

The whole hope is to keep patients alive but if they die bankrupt because of their medical bills they probably couldn't afford much in the last few weeks to enjoy life?

Something is broken here in many ways.

More on health costs

In a recent study (because we needed another study), it was shown that 26% had a gap in their health insurance coverage in 2011. Why did they have gaps? Job loss or change was a big reason. And the majority had no insurance for more than two years.  The reasons for not getting new insurance included high cost of insurance, denial of coverage, and exclusion of coverage for a pre-existing condition.

Then another article, the same one I blogged on yesterday, spoke about cancer costs and why they are so high: Chemotherapy is expensive. New advances have allowed it to be delivered in a pill form. But then insurance covers a much smaller portion.

Another significant reason is health care is more expensive in the US than anywhere else in the world. Much of the medical research happens here which means the US patient is paying for the research that benefits the rest of the world. Is there fairness here? I don't think so. '... medical care providers and drug companies have the upper hand when it comes to price negotiation. The customer/patient is, by definition, in a tight spot.'

Cancer patients bear the brunt of the costs of care.  Even those with insurance average $712 per month in out-of-pocket medical expenses. 'The rates of personal bankruptcy are two to six times higher for cancer patients and survivors.
This expense, whether borne by patients, in the form of copays and insurance premiums, or by the public in the form of taxes, takes a toll. One of the hidden costs is apathy.'

Hmmm.... maybe there is room for some change here.

The health care controversy

Next week the Supreme Court will tackle health care reform, or the Affordable Care Act, or Obamacare - or whatever you want to call it. Some people like it, some people hate it. I am relatively impartial. While I like some of the changes - no pre-existing condition exclusions, no more life time caps on benefits, children can remain on parent's health insurance for another three years, more well people scans, and other items. I am also not looking forward paying any more than I already am or having to wait longer for care.

But I have also taken a wait and see approach. I see no need to jump up and down and take a stance that 'it will not work' or 'it must happen the way it is written' because we don't really know how it will work. Already, there is insurance available for those with pre-existing conditions but only 50,000 people have signed up - which is much lower than what was expected.

I do believe the current situation has to change - the insurance companies should not make medical decisions for the patients and just because you get sick  your insurance company should not be able to cut off your benefits. That's like your car insurance company saying because you get in an accident, they can cut you off. Oh, that's right they do that too. Insurance companies should not rule the world.

I recently had a Facebook 'discussion' with someone who is against the proposed changes. She had been told by her child's doctor that it was wrong. She could quote from various right wing online sources that were against the ACA. But could she articulate more? No, quoting from others was about it.

While I welcome dissension and embrace my inner rebel, I believe I need to form my own opinions and don't need to use others' rants to express an opinion. While I cite articles, I use mainstream sources and don't refer to extremist opinions to explain my stance.

If you agree or disagree with anything, please state your own words and have a discussion with me. After more than 30 years with cancer and worrying about not having health insurance or being told I had a pre-existing condition, I welcome change that would allow me and others not to have to worry about life time caps or loss of insurance just because a whim of the industry.