The Formulary Files

Oncology drug shortages drive cost of care up

As the cost of cancer care hits all-time highs, payers are engaging oncologists in ways to make treatment as cost-efficient as possible. Clinical pathways, bundled payments, and physician performance incentives are but a few of the ways payers and physicians are working to improve treatment outcomes while reducing unnecessary expenses.

But there’s an aspect to cancer care costs that is largely overlooked — and, often, out of the hands of physicians at the patient-care level: shortages of common oncology drugs. In a survey report presented at this summer’s American Society of Clinical Oncology annual meeting, 83% of oncologists said they had been unable to prescribe a preferred chemotherapy agent in the past six months because of drug shortages. Often, when the drug they want can’t be found, oncologists turn to a more expensive agent.

Most commonly reported shortages

Percentage of oncologists who experienced shortages with these drugs

Percentage of oncologists who experienced shortages with these drugs

Of the 210 oncologists who reported experiences with drug shortages, 38% substituted brand-name drugs for generic chemotherapy agents. Levoleucovorin (Fusilev), for instance, is a common substitution for leucovorin. Informally, some physicians told researchers that because of ongoing problems with the drug supply, they have begun to use the higher-cost drugs as their standard of care.

The methods used to deal with drug shortages not only drive up costs; respondents also acknowledged the potential for affecting treatment outcomes.

How did you adapt to the drug shortage?

Oncologists' adaptive strategies to deal with drug shortages

Source: Emanuel EJ, et al. Impact of oncology drug shortages. J Clin Oncol. 2013:31(suppl; abstr CRA6510).

The degree to which shortage protocols can minimize outlier costs is unknown, but there is clearly room for improvement. About 70% of respondents said they had received no formal guidance for drug allocation or substitution during shortages. Guidelines are more likely to exist at academic medical centers than at community-based practices. The lack of guidelines has implications for integrated health systems, ACOs, and payers working to make treatment cost-effective.

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