Cancer patients who receive life-prolonging drugs often face bills for those therapies that are several times greater than their annual family income.
That was one of a number of concerns expressed in commentary published Thursday by more than 100 cancer specialists from across the country. They urged federal involvement in addressing soaring drug prices, which they say ultimately harms patients.
“The good news is that effective new cancer therapies are being developed by pharmaceutical and biotechnology companies,” said the letter posted online in the Mayo Clinic Proceedings. But “the current pricing system is unsustainable and not affordable for many patients.”
The introductory cost of new cancer drugs has increased 100-fold over the past 50 years. The cost of a newly approved therapy averages $10,000 per month, with some exceeding $30,000 per month, according to estimates.
The number of Americans taking at least $100,000 worth of prescription drugs annually tripled from 2013 to 2014, a recent report found. Drug costs for diseases like cancer and hepatitis C were key drivers of the increase.
Policymakers, clinicians and a broad array of specialty organizations have been weighing in with potential solutions to curb the unsustainable costs.
The letter from cancer experts this week recommended allowing the Patient-Centered Outcomes Research Institute to include drug pricing in their assessments of a treatment's value. The independent organization, created through the Affordable Care Act to support comparative effectiveness research, has approved more than $845 million in funding for nearly 400 research projects, though it has also been criticized for failing to generate timely results.
Federal law generally bars HHS from considering cost in Medicare coverage decisions. Efforts several years ago to allow consideration of cost prompted a conservative firestorm over alleged "death panels."
The letter also suggested that the CMS be allowed to negotiate drug prices for the traditional Medicare program. Federal law currently prohibits the agency from negotiating prices with pharmaceutical companies for traditional Medicare, though Part D Medicare drug plans, Medicare Advantage plans, state Medicaid programs, and the Veterans Health Administration can negotiate drug prices. But some Democrats and many health policy experts are challenging that prohibition as drug prices continue to burden the nation's economy.
The pharmaceutical industry and many Republicans vehemently oppose letting Medicare negotiate drug prices. Other advanced countries have systems in place to negotiate drug prices for their national health insurance systems, and they generally pay lower prices than drugmakers charge in the U.S.
In addition, the cancer specialists in their letter recommended creating a mechanism to review fair pricing for drugs approved by the Food and Drug Administration. But other experts have said evaluating pricing post-approval might be too late.
A project announced Tuesday by the Institute for Clinical and Economic Review (ICER) will begin releasing reports in September that will compare the clinical effectiveness of drugs, their prices and their potential impact on the economy before the drugs are federally approved and enter the market.
ICER president Dr. Steven Pearson said the U.S. needs an independent, objective source to look at the evidence on clinical effectiveness and then focus on the incremental costs downstream. “What we're trying to do is create a transparent way to look at the relationship of the price with the value the drug brings to patients,” he said.
Dr. Peter B. Bach, director of the Center for Health Policy and Outcomes at the Memorial Sloan Kettering Cancer Center, said he agreed that an independent body is needed to objectively evaluate the evidence. In mid-June he launched a website called DrugAbacus as a road map for comparing particular drugs' potential harms with the quality life years they yield, and to use this calculus to come up with appropriate pricing for the drug.
“Right now patients don't have any fair boundaries for absolutely vital health decisions," he said. "It's totally unreasonable and unfair.”