"Uncertain Times" for Efforts To Curb Cancer Drug Price Rises

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Cancer drug prices will probably continue their steady climb.
Cancer drug prices will probably continue their steady climb.

Cancer drug prices will probably continue their steady climb, according to a plenary presentation at the 2016 San Antonio Breast Cancer Symposium.1

“You often hear that only 10% of health care spending is on drugs—but that's not true—the actual number is 19% and rising,” said Peter B. Bach, MD, MAPP, director of Memorial Sloan Kettering Cancer Center's Center for Health Policy and Outcomes in New York, New York.

Medicare spending projections for the next decade and 50 years show that the costs of cancer therapies and other drugs will outpace other health care spending.

“These are serious numbers that are going to cause serious strain,” he said.  “For any patient on a couple of drugs or more, costs badly outstrip inflation.”

Rising launch prices for new drugs are one problem, Dr Bach said. The monthly, inflation-adjusted cost of cancer treatments has climbed steadily since the 1960s, and particularly the 1980s.

“There has been a 100-fold increase in month costs of drugs for the average adult,” he said.

Old drugs' prices are rising too, he added, citing the recent controversy over Mylan's EpiPen.

Drugs are also coming to market with “huge” patient populations. “The hepatitis C drugs alone accounted for $18 billion in new spending in 2014 and 2015,” Dr Bach noted.

Comparing the prices of Gleevec and iPhones over time, Dr Bach pointed out that most technologies become better values over time. The iPhone's processing value per dollar has climbed steadily over recent years, for example. “But Gleevec, which stays the same, and its price is rising.”

Drug prices are rising faster than the life-year gains they represent, he said.  The United States ranks near the bottom of western nations in terms of access to cancer drugs but also spends more per cancer patient than other countries, even if you count those patients for whom access is limited.

More Americans are now insured, but health insurance “has been stripped down in terms of what it covers,” thanks to deductibles and copays, Dr Bach said. Sixty-three percent of plans purchased on the “Obamacare” exchanges expose patients to more than a third of drugs' actual costs, thanks to out-of-pocket policy provisions.

Patients' out of pocket costs are associated with treatment delays. The delay between diagnosis and filing prescriptions for tyrosine kinase inhibitors (TKIs), for example, can exceed 40 days for patients who must pay out of pocket, he said.

Efforts to address drug price and value have included Dr Bach's own DrugAbacus.org. Professional organizations like the American Society of Clinical Oncology (ASCO) are moving toward providing patients with price and value information at the point of care, on a laptop or tablet.

There have also been recent efforts to promote “value-based” or outcomes-contingent pricing for drugs, Dr Bach noted.

“If a patient responds then you pay the company a certain amount,” he explained. “The price is married to how well it works.”

But the trend now seems to be moving toward shifting even more of the cost of drugs and health care generally onto patients, increasing cost-sharing provisions.

Republicans like President-elect Trump's Health and Human Services Secretary Tom Price tend to favor “skin in the game” solutions like health savings accounts, for example.

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Proponents of health savings accounts believe market forces will work to curb drug prices if patients are sufficiently exposed to costs, Dr Bach said.

“We are entering an uncertain political time and it is difficult to ascertain which of these forces will prevail,” he cautioned.

Reference

  1. Bach P. Global costs of cancer care. Paper presented at: 39th San Antonio Breast Cancer Symposium; Dec 2016; San Antonio, TX.

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