Typically, the price of a drug falls entirely on the patient--and obtaining drugs is a matter between the patient and their insurance company. However, oncologists are unique in that they buy many drugs up front and deliver them intravenously in their office. And lately, with the cost of some biologic cancer drugs now reaching as much as $100,000 per year, some doctors have been put under enormous pressure, as they're stuck buying the drugs first and waiting for reimbursement from patients and insurers.
For example, while it costs $56,000 for a course of cancer drug Avastin, it can take 90 days to be reimbursed by Medicare or commercial insurance plans. Meanwhile, with steadily rising co-pays, patients are having trouble coming up with their portion of the cost. For example, if they have a 20 percent co-pay on Avastin, their share of payment would be $11,200. Meanwhile, Medicare has cut payments on IV drugs aggressively, with margins now at 6 percent rather than the 50 percent typically for some chemo meds in the past.
Given these costs--and the delays that can occur in getting repaid--some oncologists are going deep into debt to purchase such drugs. Sometimes, they're put in a position where they're questioning whether they should offer patients these new drugs, some of which provide new options for critically-ill cancer patients. What makes the ethical dilemma even tougher is that these drugs don't cure cancer, but more often hold out the promise of extending a patient's life by a few months. Increasingly, oncologists are putting these issues on the table when they discuss care with patients.
According to a recent survey reported in the Journal of Clinical Oncology, 42 percent of cancer physicians said they regularly raised the issue of costs when discussing treatment options with their patients, and that 23 percent said costs influence their treatment decisions. What's more, 16 percent said they don't discuss hugely expensive treatments when they know the costs will be extremely difficult for patients to manage.
To learn more about this trend:
- read this Wall Street Journal piece (sub. req.)
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