High Co-Pays Inhibit Access for Cancer Patients

January 27, 2014

by Amanda Conschafter, Blog Editor

You can’t put a price on health, the saying goes.  But for certain leukemia patients who need protein kinase inhibitor treatment, cost can prove to be not only a key factor but also a barrier to wellness.

A recent study from The Journal of Clinical Oncology suggests that patients burdened with high co-payments are 70 percent more likely to quit taking their medication (and 40 percent more likely to skip doses).  Straying from the doctor’s orders proves particularly tragic, because tyrosine kinase inhibitor (a type of protein kinase inhibitor) treatments can increase the rate at which patients survive for at least five years – from 30 percent to 89 percent.

In short, the medication works – but only if the patient can afford it. The study also reported that per-patient monthly medication expenses rose from $2,798 in 2001 to $4,892 in 2011.  These expenses typically took the form of co-payments.

But affordability is a multi-faceted issue here. At least one significant cost factor is the form of the medication.  When patients receive chemotherapy intravenously, the cost generally falls under medical benefit coverage.  Oral chemotherapy, however, qualifies as a prescription benefit – hence, the co-payment requirement.

To address this discrepancy, several states and the District of Columbia have passed legislation to achieve parity for oral cancer treatments.  But even this step cannot solve the problem completely.  The policies don’t apply to beneficiaries of Medicare and Medicaid; and nearly 60 percent of people on private health plans are exempt.  (Self-insured plans and federal employee plans are frequently exempt from state regulation and therefore not bound by parity laws.)

While policymakers work to address this conundrum, patients face a grave dilemma.  Study data suggests that deviating from prescribed treatment by even 15 percent can prompt relapse.  But for some patients, co-payment costs keep proper treatment just out of reach.

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