Cancer Patients’ Cost Burden Fuels Continued Debate

August 20, 2015

by Amanda Conschafter, blog editor

Rising costs have brought public debate on patient access to cancer medications to a head. In a recent joint editorial published in Mayo Clinic Proceedings, 117 physicians advocate for reform to reduce the cost burden of cancer care, which can consume as much as half of patients’ annual income. The group’s editorial proposes, among other ideas, patent limits and the importation of drugs across the U.S. border to reduce overall drug costs. In response, pharmaceutical manufacturers point out the value of innovative drugs to cancer patients – and the importance of maintaining a marketplace that incentivizes their development.

So where does that leave patients? As Dr. Ayalew Tefferi, a Mayo Clinic hematologist who co-authored the editorial, explained to NPR.org, “A lot of my patients cry — they’re frustrated. Many of them spend their life savings on cancer drugs and end up being bankrupt.”

[INFOGRAPHIC: Your Money or Your Life?]

The physicians’ editorial notes that cancer affects one in every three people, for whom “…effective new cancer therapies are being developed by pharmaceutical and biotechnology companies at a faster rate than ever before.” As a pharmaceutical trade association representative noted, “Death rates are down, survival rates are up, and quality of life continues to improve.”

With patients required to pay as much as $25,000 or $30,000 per year out-of-pocket, however, access to those therapies isn’t guaranteed. As the physicians point out, 10 to 20 percent of patients don’t take their cancer medications as prescribed. The editorial’s authors advocate for overall drug cost reduction to solve the problem, but they may overestimate its direct effect on patient access. Many insurance plans place cancer drugs on a specialty tier requiring a 20 or 30 percent co-insurance payment from patients. Thus, even a significant reduction in cancer medications’ costs would provide only a modest reduction in patients’ out-of-pocket expenses, leaving access challenges unsolved.

[INFOGRAPHIC: When Cancer Cost-sharing Turns Toxic]

The challenge therefore lies in legitimately improving access while continuing to encourage the innovation that allows breakthrough cancer medications’ development. Developers of new therapies argue that policymakers would serve patients better by focusing on improved medication coverage, noting that cancer drug costs represent only one percent of total health care spending in the United States.

For more on patient access to vital cancer medications, watch the Alliance for Patient Access’ “Protecting Cancer Care.”

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