Oncologists discuss the high cost of cancer drugs and suggest potential strategies to ease this burden

Increasingly high prices for cancer drugs are affecting patient care in the United States and the American health care system overall, according to the authors of a special article published in Mayo Clinic Proceedings (2015; doi:10.1016/j.mayocp.2015.01.014).

"Americans with cancer pay 50% to 100% more for the same patented drug than patients in other countries," said coauthor S. Vincent Rajkumar, MD, of Mayo Clinic Cancer Center in Rochester, Minnesota. "As oncologists we have a moral obligation to advocate for affordable cancer drugs for our patients."

Rajkumar and his colleague, Hagop Kantarjian, MD, of MD Anderson Cancer Center in Houston, Texas, said that the average price of cancer drugs for approximately 1 year of therapy increased from $5,000 to $10,000 before 2000 to more than $100,000 by 2012. Over nearly the same period, the average US household income decreased by approximately 8%.

In the paper, the authors rebutted the major arguments the pharmaceutical industry uses to justify the high price of cancer drugs, namely, the expense of conducting research and drug development, the comparative benefits to patients, that market forces will settle prices to reasonable levels, and that price controls on cancer drugs will stifle innovation.

"One of the facts that people do not realize is that cancer drugs, for the most part, are not operating under a free market economy," said Rajkumar. "The fact that there are five approved drugs to treat an incurable cancer does not mean there is competition. Typically, the standard of care is that each drug is used sequentially or in combination, so that each new drug represents a monopoly with exclusivity granted by patent protection for many years."

Rajkumar and Kantarjian said other reasons for the high cost of cancer drugs include legislation that prevents Medicare from being able to negotiate drug prices and a lack of value-based pricing, which ties the cost of a drug to its relative effectiveness compared to other drugs.

The authors recommended a set of potential solutions to help control and reduce the high cost of cancer drugs in the United States. Some of their recommendations are already in practice in other developed countries.

Their recommendations include allowing Medicare to negotiate drug prices and developing cancer treatment pathways/guidelines that incorporate the cost and benefit of cancer drugs. Also, they recommend allowing the Food and Drug Administration or physician panels to recommend target prices based on a drug's magnitude of benefit (value-based pricing).

They recommend eliminating pay-for-delay strategies, in which a pharmaceutical company with a brand name drug shares profits on that drug with a generic drug manufacturer for the remainder of a patent period, effectively eliminating a patent challenge and competition.

They also recommend allowing drugs to be imported from abroad for personal use. They also want to allow the Patient-Centered Outcomes Research Institute and other cancer advocacy groups to consider cost in their recommendations.

Finally, they recommend creating patient-driven grassroots movements and organizations to advocate effectively for the interests of patients with cancer to balance advocacy efforts of pharmaceutical companies, insurance companies, pharmacy outlets, and hospitals.

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