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Posts made in September 2015

Holding Patients Hostage As Cost of Care Escalates



Cost-of-care (1) - CopyAccording to a report from IMS Health Institute for Informatics a global information and technology Services Company, and the largest vendor of U.S. physician prescribing data, global spending on prescribed medications is forecast to reach nearly $1.3 trillion by 2018, up nearly 30% from last year.

The reason for the projected increase is an interesting convergence of expensive specialty medicines that are used to combat cancer and other hard-to-treat illness and the fact that there are fewer blockbuster medicines losing patent protection and thus fewer opportunities for payers and patients to benefit from lower-cost generics.

Global spending on cancer medications alone is expected to reach approximately $100 billion in 2018, up from $75 billion just five years ago. These costs are going to increase, and could rise as high as $147 billion in 2018, according to Mike Mulcahy in an article in Medscape Medical News, May 6, 2015.

Several organizations including: the National Comprehensive Cancer Network (NCCN), an alliance of 26 cancer centers, Memorial Sloan Kettering Cancer Center in New York, and ASCO, the  American Society of Clinical Oncology, concerned about the high cost of cancer treatments, are acting aggressively to develop tools that could help patients understand the actual cost of specific treatments and how they can determine which treatment is best in terms of both cost and efficacy.

This would be revolutionary in our health care system: a system that has worked hard to hide the cost of care from the patient; a system where providers genuinely do not know what the cost of care is, even though they originate the treatment plan; a system where pharma companies are allowed by law, to charge whatever they want, with no constraints. Ours is a health care system that up until now has completely disregarded the ability of patients to pay the price for needed medications.

For example, ASCO has developed a program which allows oncologists to compare various drug treatments for four common cancers based on survival, side effects and costs.  ASCO contends that it is no longer enough to just know how different treatments compare on clinical outcomes. Physicians and patients need to know what a specific treatment is going to cost and if it is feasible to consider.

Unfortunately, patients cannot rely on their physicians to choose what is best. CMS has released data that indicates that significant portions of Medicare Part B payments to oncologists go toward the drugs administered in their offices with no one controlling the price, or the effectiveness of the treatment. The law that allows pharma companies to charge whatever they wish, passed during the Bush administration, also encourages  physicians to choose  higher-cost treatment, since  they can get a piece of the pie. Currently, Medicare pays practices the average sale price of physician-administered drugs plus 6%. As a result, some physicians may opt for the higher price drug, even when the potential benefit is equivalent to a less expensive therapy.

Furthermore we must consider that, although the CMS data is available to the public, how many patients undergoing treatment for a life-threatening illness are going to do the extensive research required to obtain all the information necessary to understand their options and the cost of those options?  How many when armed with this information are willing to challenge the very doctors who they have chosen to care for them?

In an interview with CBS television, Dr. Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering, admitted that a cancer diagnosis has become one of the leading causes of personal bankruptcy.

How could it not? Case in point: One of the most widely used drugs for several cancers including certain types of lung, colon, ovarian, brain and kidney cancer is Avastin from Genentech. Avastin can cost $4,000 to $10,000 per month, depending upon the type of cancer and the mark- up that Genentech, charges.A newer drug, Zaltrap, developed by the French Drug Manufacturer Sanofi to compete with Avastin to treat colorectal cancer, costs as much as $11,000 per month more than Avastin.

AT Memorial Sloan-Kettering Cancer Center, doctors made a decision that they are not going to give this expensive new cancer drug to their patients. According to this group of physicians, the drug, has proved to be no better than a similar medicine they already use for advanced colorectal cancer, at half the price.

General retain products that cannot be proven to have an advantage over their competitors, and sell for significantly higher prices never make it to the market. But that is not how things work for drugs that have been approved by the F.D.A. here in the U.S. Once F.D.A. approval is granted Medicare must cover the drug by law.

With the mega dollars that the pharma companies spend on advertising and promotion, patients are swayed into believing that these are miracle cures that they cannot afford to reject.  However, studies show that many of  these drugs prolong life for most users for only a few months, if that.
Holding patients hostage as they grapple with the complex choices of life-saving treatments is unacceptable. It is going on three years since the doctors at Memorial Sloan Kettering refused to prescribe the more expensive drug. It is time to put the sophisticated data collection and dissemination technology that is available throughout industry to use in healthcare. It is time to make price transparency and health outcomes data available to everyone. Armed with that information, patients hopefully can make intelligent choices about expensive treatments that often do not prolong their life but certainly clean out their bank accounts.