Fwd: qotd: High cancer drug prices

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-------- Original Message --------
Subject: qotd: High cancer drug prices
Date: Wed, 14 May 2014 11:48:36 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Journal of Oncology Practice
May 6, 2014
High Cancer Drug Prices in the United States: Reasons and Proposed Solutions
By Hagop Kantarjian, MD, David Steensma, MD, Judit Rius Sanjuan, Adam
Elshaug, MPH, PhD and Donald Light, PhD

The increase in cancer drug prices in the last 15 years has many
contributing factors and is harming our patients and our health care
system. It represents to many cancer experts a crossing of a moral line
between reasonable profits and profiteering, in a situation involving a
human catastrophe: patients who have developed cancer, and who may die
because they cannot afford the treatment. With typical out-of-pocket
expenses of 20% to 30%, the financial burden of cancer treatment would
be $20,000 to 30,000 a year, nearly half of the average annual household
income in the United States. Many patients (estimated 10% to 20%) may
decide not to take the treatment or may compromise significantly on the
treatment plan. This difficult situation poses three relevant questions:
(1) Are cancer drug prices too high? (2) Are they hurting patients and
our health care system? and (3) Can we do something about it? The answer
to each is affirmative. It is also our obligation as cancer doctors to
keep patients from "harm and injustice." If high prices make drugs
unaffordable and inaccessible, thus causing harm, then we should voice
our concerns and advocate for solutions.

What would be a just price for a cancer drug? A simple answer would be a
price that recognizes that most risks and costs of development are borne
by the public through tax breaks and public funding, so that cancer
drugs are affordable. The prices would maintain reasonable profits to
drug companies but remain fair, accessible and affordable to patients
and to the health care system.

What are some potential solutions? The United States is on the precipice
of great change in how we measure value in health care. In a recent
survey of US oncologists, 80% favored more use of cost-effectiveness
data in coverage decisions. In 2011, the American College of Physicians
outlined the position that "There should be a transparent and publicly
acceptable process for making health resource allocation decisions with
a focus on medical efficacy, clinical effectiveness, and need, with
consideration of cost based on the best available medical evidence."
Several solutions could help reduce cancer drug prices. Reviewing and
reducing the research bureaucracy and burdens could eliminate
unnecessary steps that increase cost, delay timelines, and shorten drug
patent times. Allowing Medicare to negotiate drug prices, eliminating
pay-for-delay strategies; allowing importation of drugs from abroad for
personal use; and allowing PCORI and other cancer advocacy groups,
experts, or committees to consider cost in their recommendations, would
all enhance the capacity of market forces to produce more reasonable
cancer drug prices. Professional societies representing cancer
specialists and advocating for cancer patients should be involved in
reducing the hype around new cancer drugs that do not have a major
impact on patient outcomes. They could also develop pathways and
guidelines that incorporate estimates of a drug "value" (benefit,
toxicities, cost, etc). A broad-based group representing cancer experts,
PCORI, patients and their advocates, regulatory bodies, and
pharmaceutical and insurance companies could review the new drugs for
their cost and benefit after US Food and Drug Administration approval,
and formulate cancer treatment pathways that incorporate the costs and
benefits of cancer drugs. Such structures are in place in many other
countries. These include, for instance, the Pharmaceutical Benefits
Scheme in Australia, the Pharmaceutical Market Restructuring Act in
Germany (AMNOG; affects prices in 31 countries), and others (Canada,
United Kingdom, New Zealand, France, etc). These structures have been
documented to result in more reasonable cancer drug prices (based on
expected benefits), which improves affordability and promotes high
levels of access for the population. For manufacturers, this creates
predictable markets with strong drug penetration, and ultimately
generates better profits to drug companies.

http://jop.ascopubs.org/content/early/2014/05/06/JOP.2013.001351.abstract

****


Comment by Don McCanne

As this article indicates, there are many things that could be done to
reduce prices of, not just cancer drugs, but all new drugs that enter
the market with exorbitant pricing. Just think how much easier this
would be under a single payer system.