The Alliance for Patient Access / IfPA’s Patient Access Policy Blog / Cost, Quality Debates Dominate Cancer Policy Workshop

Cost, Quality Debates Dominate Cancer Policy Workshop

by Amanda Conschafter, Blog Editor

How do we go about ”Ensuring Patient Access to Cancer Drugs”? Ethicists, economists, physicians and academics gathered for the Institute of Medicine’s National Cancer Policy Forum Workshop this week to discuss the topic. Their debates centered on challenges in oncology care, such as:

  • Oral vs. IV Chemotherapy. In a paradox that still complicates cancer care, many patients opt for chemotherapy infusion in a hospital or doctor’s office instead of taking the pill form in the convenience of their own homes. The primary rationale, said Dr. Lee Newcomer of United Health Group, is cost. IV therapy falls under patients’medical benefit, while oral therapy falls under the pharmacy benefit –for which patients will likely pay more out of pocket through co-insurance or higher co-payments.Many states have now passed cancer parity laws. But, Dr. Newcomer noted, Medicare has not – leaving seniors to pay as much as 50 percent of their cancer medication costs.
  • Brand vs. Generic Drugs. Cheap, generic drugs increase patient access –at least in theory. But Dr. Jeffrey Peppercorn of Duke University Medical School pointed out that Medicare reimbursement models, adjusted in 2012 to cut program costs, actually encourage doctors to prescribe higher-price, brand-name drugs so they can also cover related expenses. Meanwhile, shrinking profit margins for generic drug manufacturers inspire growing drug shortages. Dr. Peppercorn also predicted that generics’ core appeal – similar benefit at lower cost – may not apply to biologic medications and their biosimilar substitutions. As biologics’ patents expire, Dr. Peppercorn explained, it may take “three times longer” and cost much more to access the biosimilars that follow.
  • 340B intent vs. 340B results. The federal 340B program was created to allow “underfinanced”doctors to treat Medicaid patients, Rena Conti, Ph.D. of The University of Chicago explained, by deeply discounting needed drugs. But a series of mergers and acquisitions among 340B-qualifying hospitals and their affiliates have rapidly expanded the network of providers eligible for 340B discounts. As more providers treat patients whose insurance pays more than the discounted drug price, 340B hospitals realize a profit from the program. That opportunity to profit, Dr. Conti argued, has “eroded” the program’s goals. Refocusing 340B requires greater transparency among users of this program, Dr. Conti concluded.

Panelists agreed on the impetus to address these challenges as health care costs continue to rise and the Affordable Care Act prompts many patients, insurers and providers to reconsider their approach to cancer care. With 1,665,540 new cancer cases expected in 2014, these debates promise to grow in both intensity and relevance.

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