Established in 2014, the Oncology Therapy Access Physicians Working Group is a home for oncologists interested in health policy issues relating to access to cancer therapies. Working Group members collaborate in development of educational resources such as white papers, policy briefs and videos to be utilized in encouraging informed policymaking, while ensuring the physician’s perspective is shared as policymakers consider how to balance access and costs.

Due to improvements in the US Food and Drug Administration (FDA) review process for cancer drugs, many transformative new cancer drugs have been approved over the past decade. About 70% of all sales of cancer drugs in North America and the European Union are of agents introduced in the past 10 years. These new therapies have dramatically improved survival rates for cancer patients. However, when coverage and payment policies impair a cancer patient’s access to therapy mutually agreed upon between physician and patient, there may be life and death consequences.

In an effort to restrict the utilization of expensive specialty drugs, many insurers have added a fourth tier to their pharmacy benefit plans. In contrast to the modest copayments required for other tiers, the fourth tier usually requires that patients pay a percentage of the drug cost (ie, coinsurance). Coinsurance payments, which generally range from 20% to 33% of the drug cost, can exceed $10,000 each year. Elderly patients with Medicare coverage who receive their chemotherapy in the clinic setting are subject to similar coinsurance payments. As a result, many patients are effectively restricted from receiving the most advanced cancer treatments simply because they can’t afford the coinsurance payments.

Another protocol health plans may impose is to force a cancer patient to first fail older, potentially more toxic agents that are less expensive before the patient is able to access to more innovative and advanced therapies. The time lost trying the outdated treatments may dramatically impact the patient’s condition.

The slippery slope of payers rationing these new and innovative treatments presents the potential of a domino effect whereby a greater number of newer treatments for more prevalent forms of cancer are withheld from patients in need.


Alan Marks MDAlan Marks, M.D. serves as Chairman of AfPA’s Oncology Therapy Access Working Group. A passionate advocate for public policy that supports optimal cancer care, Dr. Marks is the current president of the Florida Society of Clinical Oncology. Board certified in internal medicine, medical oncology and hematology Dr. Marks has also served on the clinical faculty of the University of Florida School of Medicine.

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