President's Cancer Panel -- Urgent Action on Drug Prices

Rein In Drug Prices and Align Them With Value

Roxanne Nelson, RN, BSN

March 14, 2018

In a new report, the President's Cancer Panel stresses that urgent action is needed to address the ongoing and rapidly rising cost of cancer drugs.

This challenge can only be met, according to the report, through "input and action of all stakeholders — drug developers and manufacturers, policy makers, government, public and private payers, healthcare institutions, and systems, providers, and patients."

Efforts are required from all stakeholders to ensure that all cancer patients have access to affordable treatment and to promote future innovation in oncologic therapeutics.

The cost of cancer drugs has steadily increased during the past 2 decades, from more than $54,000 in 1995 to more than $200,000 in 2013, with no sign of slowing down, according to the report. As previously reported by Medscape Medical News, drug costs are higher in the United States than anywhere else in the world.

The new report reiterates what has already been stated many times over, that the escalating cost of cancer drugs is untenable and has to be addressed. The three-member advisory panel, which was funded by the National Cancer Institute, met during the past 2 years and has developed recommendations to curb drug cost and improve access to patients.

Key Recommendations

One of the key recommendations is that drug price should reflect the drug's value to the patient and that steps must be taken to "better align drug prices and costs with their value and promote use of high-value drugs."

This recommendation reflects frameworks that have been proposed by organizations such as the American Society of Clinical Oncology and the European Society for Medical Oncology, as well as individual experts, that call for a "real and consistent" relationship between cost and the benefits of a drug.

Another key recommendation is that there must be "meaningful communication about treatment options, including cost information," that will support patients' decision making. For this to be accomplished, patients must be given accurate information about their disease and have a clear understanding of treatment options, as well as access to information about the cost of options. This information should be provided by the cancer care team and should be tailored to the individual patient's needs, preferences, and ability to comprehend.

A third recommendation is to minimize the contributions of drug costs to the "financial toxicity" that cancer patients and their families often have to contend with. Although out-of-pocket costs for cancer drugs vary widely, depending on a number of factors, the shift toward high-priced specialty drugs has led to substantial increases in the patient's cost burden.

According to the report, the average out-of-pocket costs for cancer drugs increased from $450 per month in 2001 to $647 per month in 2011, which coincides with the growing use of targeted therapy.

The fourth recommendation stresses the need for stimulating and maintaining competition in the generic and biosimilar cancer drug markets. Although the prices for branded drugs have risen dramatically, those for generics have dropped by more than 70% since 2008, and the US generic drug market has saved the healthcare system an estimated $253 billion in 2016. Of this amount, $10 billion was for savings on oncology drugs.

However, to do this, the US Food and Drug Administration (FDA) needs to reduce barriers for generic manufacturers to enter markets where there are currently no generic drug options or too few generic drug options so as to create competition and lower prices, the panel comments. The FDA needs to review and institute approval processes that will facilitate timely market entry of generic drugs.

A fifth recommendation emphasizes that the FDA must have appropriate resources to properly do its job. The Oncology Center of Excellence was established to enable more efficient and effective review of cancer treatments, and the advisory panel notes that the president and Congress must "ensure that the FDA has the resources and authority to assess the safety and efficacy of oncology products and to appropriately staff the Oncology Center of Excellence."

The last key recommendation calls for investment in biomedical research so as to create a strong foundation for developing innovative, high-value cancer drugs. The National Institutes of Health (NIH) has an annual budget of $32.3 billion, but since 2003, its budget has not kept pace with inflation. Therefore, the panel urges that the NIH receive sustained and predictable funding that, at a minimum, will keep pace with inflation.

"NIH funding is essential to the National Cancer Program and will lay the foundation for development of innovative drugs that provide high value to cancer patients," says the report. "Failure to invest in NIH will threaten the United States' role as a global leader in the biomedical sciences and future progress against cancer."

President's Cancer Panel. Promoting Value, Affordability, and Innovation in Cancer Drug Treatment. Full text

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