Report: Sticker Shock Forces Thousands of Cancer Patients to Skip Drugs

Elderly hit hardest when bills arrive

With new cancer drugs commonly priced at $100,000 a year or more, hundreds of thousands of cancer patients are delaying care, cutting their pills in half, or skipping drug treatment entirely, a Kaiser Health News (KHN) examination has found.

The KHN report offers the following examples:

  • One-third of Medicare patients who were expected to use imatinib mesylate (Gleevec, Novartis)––a lifesaving leukemia medication that costs up to $146,000 a year—failed to fill prescriptions within six months of diagnosis, according to a December 2016 study in the Journal of Clinical Oncology.
  • Researchers at the University of North Carolina found that patients with private health insurance with relatively high monthly copayments ($53 or more) were 70% more likely to stop taking imatinib or to take fewer doses than prescribed, according to a 2014 study.
  • A 2013 study published in The Oncologist found that 24% of all cancer patients chose not to fill a prescription because of cost, while approximately 20% filled only part of a prescription or took less than the prescribed amount.
  • Another study published in Cancer had similar findings, with approximately 10% of patients skipping their cancer medications or taking less than prescribed, and 14% delaying filling a prescription.

Doctors call the problem “financial toxicity,” the KHN article says.

“We’re talking about huge numbers of patients,” said Dr. Scott Ramsey of the Fred Hutchinson Cancer Center in Seattle. “It’s an epidemic. And it’s not going away.”

Even patients with good insurance can face a financial crisis when trying to pay for cancer therapy, according to the article. Medicare pays for the bulk of cancer care in the United States because 59% of cancer patients are older than 65 years of age.

Unlike many commercial plans, Medicare doesn’t set an upper limit on what patients pay out-of-pocket. Patients with chronic lymphocytic leukemia who begin oral medications this year, for example, can expect to have lifetime out-of-pocket costs of $57,000, according to a January 2017 study published in the Journal of Clinical Oncology.

High drug costs are a particular problem for the elderly, half of whom have no more than $13,800 in available assets, and many have more than one expensive chronic condition, such as heart disease, diabetes, or emphysema. The median income for people receiving Medicare was $24,150 in 2014, according to the Kaiser Family Foundation.

Medicare patients with cancer spend an average of 11% of their incomes on treatment, according to a November study in JAMA Oncology. Patients who don’t have supplemental insurance, which pays for treatment not covered by traditional Medicare, spend 23% of their income on cancer care. Ten percent of elderly patients without supplemental insurance spend 60% of their income on cancer expenses.

While cancer has always posed a financial hardship for patients, the jaw-dropping costs of new cancer drugs have led to widespread criticism of the pharmaceutical industry on Capitol Hill and beyond, according to the KHN article.

List prices for oral cancer medications doubled from 2011 to 2016, rising from an average of $20 for a day’s supply to $40, according to Express Scripts, a pharmacy benefit manager. Six of the 39 cancer drugs on the market in 2010 doubled or tripled in price by 2016; one quadrupled in price; and one drug’s price increased eightfold.

Treating melanoma patients with the highest dose of pembrolizumab (Keytruda, Merck), an immune therapy that has led to long-term remissions in some patients, could cost more than $1 million a year.

Such astronomical price tags are leading to soul-searching by doctors, who often struggle to help patients decide whether drugs are worth the consequence of depleting their life savings, or of going into debt or even bankruptcy, KHN says.

In a statement, the Pharmaceutical Research and Manufacturers of America (PhRMA), an industry lobbying group, claimed that drug costs are only one part of the problem. “Many factors contribute to financial hardship for cancer patients. … Physician services, transportation expenses, and the inability to work, among other medical and nonmedical factors, drive the cost burden on patients. We have also seen a rapid rise in the number of health plans with high deductibles for medicines.”

Source: Kaiser Health News; March 15, 2017.