Oncologists Protest High Prices of Cancer Drugs, Again

Zosia Chustecka

July 24, 2015

Oncologists are again protesting against the high prices of cancer drugs, this time in an editorial in the Mayo Clinic Proceedings that is signed by 118 leading cancer experts.

The lead author is Ayalew Tefferi, MD, from the Mayo Clinic, Rochester, Minnesota, and second author is Hagop Kantarjian, MD, from the University of Texas MD Anderson Cancer Center, Houston, who has been campaigning against high cancer drug prices for the past few years. Dr Kartarjian was the lead author of a 2013 forum article in Blood outlining how high drug prices are harming cancer patients. That article also had many experts as cosignatories, but at that time, the arguments were focussed on leukemia; the concern has now spread to all areas of oncology.

Cost and value are increasingly becoming the most talked about issue within oncology circles.

In the latest article, the group of experts again outline how high drug prices are harming cancer patients in the United States.

All of the new cancer drugs approved by the US Food and Drug Administration during 2014 were priced at more than $120,000 per year of use, they point out.

After recent changes in medical insurance coverage in the United States, patients have to pay around 20% to 30% of the total cost of such drugs themselves (ie, patients have out-of-pocket expenses of around $25,000 to $30,000).

This is about half of the average annual household gross income in the United States, which is about $52,000.

So many cancer patients are left with "the difficult choice of spending their incomes (and liquidating assets) on potentially lifesaving therapies or foregoing treatment to provide for family necessities (food, housing, education). This decision is even more critical for senior citizens, who are more frequently affected by cancers and have lower incomes and limited assets," the group writes.

Because of the cost of treatment, about 10% to 20% of patients with cancer do not take the prescribed treatment or compromise by taking the drugs less often, and "the greater the out-of-pocket cost for oral cancer therapies, the lower the compliance," they point out. Other reports have outlined how lowered compliance results in worse clinical outcomes, including jeopardising the chance of cure and potentially shortening survival.

"This is a structural disincentive for compliance with some of the most effective and transformative drugs in the history of cancer treatment," they argue.

 
This is a structural disincentive for compliance with some of the most effective and transformative drugs in the history of cancer treatment.
 

The group of experts outlines a number of changes that could "improve the situation and allow market forces to work better." The proposed changes, many of which have already been reported in detail by Medscape Medical News, include allowing Medicare to negotiate drug prices, allowing patients to import cancer drugs from other countries where prices are cheaper, preventing pay-for-delay deals for generic versions that are much cheaper, and encouraging specialist organizations to consider value of treatments when drawing up recommendations.

Finally, the experts draw attention to the cancer patient–based grassroots movement advocating against the high price of cancer, which is using contemporary methods to address a contemporary crisis" with an online petition, Change.org, as previously reported by Medscape Medical News.

"With proper support of these grassroots efforts, and proper use of that support downstream, it should be possible to focus the attention of pharmaceutical companies on this problem and to encourage our elected representatives to more effectively advocate for the interests of their most important constituents among the stakeholders in cancer ― American cancer patients," the group of experts conclude.

Complex Scenario of Drug Pricing

The complex scenario of drug pricing in the United States was explored recently by Medscape Medical News in a full-length feature that asked, why are drugs prices so high?

Much of the blame is laid at the door of the pharmaceutical industry, with oncologists accusing pharmaceutical companies of charging sky-high prices, as high as the market will bear. "I think they charge what they think they can get away with, which goes up every year," commented Peter Bach, MD, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York City, writing last year in a guest post in Forbes.

In its defence, the industry highlights the huge cost of drug development and emphasizes that the drugs that make it to the market represent only a tiny fraction of the research and development investment that is needed to explore new therapeutic approaches. Robert Zirkelbach, senior vice president of communications at PhRMA, the trade association of the pharmaceutical industry, told Medscape Medical News in a recent interview that bringing a new medicine to the market "takes an incredibly long time, it is incredibly costly, and more fail than succeed. When you look at what it takes to bring a medicine to the marketplace, you have to look at what didn't succeed. That's a point that is almost always left out of these discussions."

"Clearly, many therapies are complicated to develop and manufacture, and there are many failures; we recognize all that. We need innovation and drugs companies to be profitable to continue R&D, and we accept all of that," commented Richard L. Schilsky, MD, FASCO, chief medical officer at the American Society of Clinical Oncology (ASCO) at that time.

But none of that provides the clear rationale for the current pricing schemata, he noted, because even drugs that are easy to develop, quick to manufacture, and receive support from foundations, government, and other sources still come out with a very high price.

Cost and value are becoming the most talked about issues within oncology. At the recent ASCO annual meeting, the subject even made it into the plenary session, with a leading oncologist warning that current pricing is unsustainable by highlighting a new immunotherapy that could cost more than $1 million per patient per year.

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