Advances in chemotherapy technology have led to the development of newer and better drugs with fewer side effects. Many of these drugs now come in pill form, eliminating the need for office visits and intravenous administration. However, these advances are coming at a steep price for many cancer patients, in that many of them cannot afford their life-saving medications. Even with government programs such as Medicaid, older patients on fixed incomes cannot pay for the drugs that can extend their lives.
A study in the Journal of Oncology Practice showed that nearly 1 in 6 Medicare patients did not request that their cancer medication prescription be filled, and that nearly half of all Medicare patients faced prescription co-payments of more than $500. Of those that faced such high co-payments, 1 in 4 did not fill their prescriptions. For patients with private insurance, less than 1 in 10 turned down getting their prescriptions filled and only 11 percent dealt with co-payments of at least $500.
Rita Moore, a kidney cancer patient from Corcoran, California, found that a month’s supply of her chemotherapy medication cost $2,400. She applied for prescription assistance through the drug’s manufacturer, who gave her a year’s supply of the drug at no charge. The paperwork process took nearly two months before she was approved. During that time, Moore was not being treated. Her cancer has spread beyond her kidneys and, at last report, lay close to her spine and other vital organs.
In the interim, the insurance carriers, Medicare benefit administrators and pharmaceutical manufacturers each blame the others for the problem. The carriers cite the structure of the Medicare prescription plan, as well as drug companies and their pricing plans, for keeping vital cancer-fighting drugs out of the reach of patients who need them the most. On the other side of the argument, drug companies blame the Medicare providers for charging unaffordable co-payments.
Dan Mendelson, president of the research firm Avalere Health, calls the problem “a benefit design issue.” Many insurance carriers classify necessary drugs, including new chemotherapy drugs, in a “specialty tier” that requires up to 25 percent co-payment from patients. The “specialty tier” was designed to prevent over-treatment and over-prescription from doctors, but Mr. Mendelson sees how the issue affects those who need their treatments most.
“It is hard to make the argument that someone who has been prescribed an oral cancer medication doesn’t need the drug,” Mr. Mendelson said.
Dr. Lowell Schnipper is the chairman of the American Society of Clinical Oncology’s task force on cancer care costs. He advises doctors and oncologists to discuss the costs of chemotherapy drugs with patients before they visit the pharmacy to avoid drug “sticker shock”. Dr. Schnipper also acknowledges the problem of how thousands of patients could miss out on vital drugs.
“Obviously, we’re leaving a lot of folks off the bus, standing at the curb,” Dr. Schnipper said, “if they can’t afford the medications.”
Dr. Jeff Kelman, Medicare’s chief medical officer, said that the department has no plans to restructure their prescription benefits package. In contrast, he also said “nobody is more concerned about (drug) access than we are”.