American Society of Clinical Oncology on astronomical drug prices

This Cancer Doctor Is Leading the Attack on Astronomical Drug Prices

By Robert Langreth and Cynthia Koons
Bloomberg Business, June 1, 2015

As the one-year cost of cancer drugs edges up to $200,000 per patient, a top doctor from Memorial Sloan Kettering Cancer Center used his speech before a massive gathering of colleagues to call for limits on the cost of cancer therapies. “These drugs cost too much,” Dr. Leonard Saltz, a gastrointestinal oncologist, said in an unusual speech at the American Society of Clinical Oncology meeting on Sunday.

“We need to first accept that there has to be some upper limit as to what we as a society are going to be willing to spend on a patient, and we have to be willing to engage in that discussion,” Saltz told Bloomberg in an interview from the meeting in Chicago. “It’s a very uncomfortable discussion. We should be willing to have it. Because we’re not having the conversation, only the people selling the drugs are weighing in on what they should cost.”

Alan Venook, an oncologist at the University of California at San Francisco and the scientific program chair for the American Society of Clinical Oncology this year, says he picked Saltz to discuss cancer costs even before he knew that the melanoma combination would be on the program. The problem of rising cancer drug costs “needed to be front and center,” Venook says, and Saltz “is somebody who will really come out there and put it on the table.”

Saltz has been among an outspoken group of physicians at Memorial Sloan Kettering that has railed against high-priced cancer drugs. In his latest broadside he lit into the cost of a melanoma drug combination from Bristol-Myers Squibb, just hours after another physician from his hospital presented data showing the combination could delay the progression of advanced melanoma by months.

The cocktail combining two existing Bristol-Myers Squibb drugs, Opdivo and Yervoy, would cost the average patient $295,000 for a little less than a year of therapy, Saltz calculated. An experimental high-dose regimen of another new drug highlighted in Saltz’s speech could cost patients as much as $1 million a year.

Anthem has implemented a program that incentivizes oncologists to use the most effective — and most cost-effective — drug by offering a bonus to doctors who put patients on the drugs the insurer deems to fit that criteria. Anthem estimates drug spending represents about a third of the cost of cancer care for the insurer, Jennifer Malin, Anthem’s medical director for oncology, said in an interview at the American Society of Clinical Oncology meeting. As for the newest cancer drugs coming to market, Malin said Anthem will look at the effectiveness and side-effect profile when making coverage decisions.


Dr Jennifer Malin on the Patient as the Payer in Oncology

AJMC TV, May 30, 2015

The move to have patients shoulder greater share of their cost of care is particularly challenging in cancer care, according to Jennifer Malin, MD, medical director for oncology at Anthem.

Does the patient becoming the payer have a different impact in oncology compared with other specialties?

Dr. Jennifer Malin:  “So I think having patients have to bear a greater share of their costs is a particular challenge in cancer care because the care is so expensive they reach their out-of-pocket maximum very quickly. So it’s overwhelming to have to come up with several thousand dollars, if you’re on a bronze plan on the exchange, you reach your six thousand dollar out-of-pocket maximum within a month or two. The data suggest that only twenty percent of people in the U.S. can be able to access a thousand dollars in savings in a course of thirty days. So it’s overwhelming when you have a major illness that’s going to be so costly. On the other hand, once you reach that out-of-pocket maximum though, then the cost of treatment doesn’t really impact you as a patient, until the next year comes around and you have to start all over again.”



By Don McCanne, MD

The outrageous price of drugs has been a topic of a plethora of news reports, and for very good reason. Thus it is encouraging that the nation’s cancer specialists, at their recent national meeting, brought the topic of rising cancer drug costs front and center.

We need to do something about it, but what options do we have? According to Dr. Saltz, “only the people selling the drugs are weighing in on what they should cost.” Oncologists have the option of simply not using the expensive drugs, but that may not be in the bests interests of the patients. And what other real option do they have?

The insurers can play a role, but that may simply be excluding expensive drugs from their formularies. Again, that may not be in the best interests of the patients. Anthem’s medical director of oncology, Jennifer Malin, clearly recognizes the burden of patient cost-sharing for these expensive drugs. So what do they recommend? They are offering bonuses to physicians who use drugs that the insurer has decided are the most effective and most cost-effective. Does anyone else see a potential conflict here that also may not be in the best interests of the patients?

Our current public policies not only allow, but specifically encourage, price gouging by the drug firms, through measures such as prohibiting Medicare from negotiating drug prices. Yet it is the government that has the responsibility to step in when the private sector tramples the marketplace with abusive, anti-consumer (anti-patient) practices.

We need more than just price controls. We need to protect patients from cost sharing that erects financial barriers to care. We need to make funding of health care more equitable. We need to be sure that everyone has affordable access to care. The obvious solution is a single payer national health program that is truly universal, that eliminates cost barriers, that is funded equitably through the tax system, and that ensures optimum value through monopsonistic purchasing which pays enough to support the health care system while avoiding excess payments that would not provide optimum value for our tax dollars.

The current Medicare program won’t quite do that, but if we improved it and then expanded it to cover everyone, then we would no longer be victims of gouging by the drug companies nor by any of the rest of the health care industry.