Cancer Treatment or Buy Groceries??

[traumaRUs]

What do you think of this?

"Urgent action must be taken to address the dramatic rise of cancer drug prices and to better align prices with value, according to a report released today by the President's Cancer Panel. The Panel's report, Promoting Value, Affordability, and Innovation in Cancer Drug Treatment, finds that while some cancer drugs have indeed been transformative, and may warrant prices that reflect their value, many new drugs do not provide benefits commensurate with their prices. The Panel concludes that stakeholders across the cancer enterprise-including drug developers and manufacturers, policy makers, government and private payers, healthcare institutions and systems, providers, and patients themselves-must work together to maximize the value and affordability of cancer drug treatment and to support investments in science and research that drive future innovations."

So...how do we do we make cancer medications more affordable?

The American Cancer Society states; "Cancer is one of the leading causes of death and disease in the U.S. The American Cancer Society (ACS) estimates that roughly 1.7 million new cases of cancer will be diagnosed in the U.S. in 20171 and more than 15 million Americans living today have a cancer history."

Almost all of us know of someone that has had or does have cancer. Many forms of cancer that were incurable now show long survival rates. However, what if you or a loved one is diagnosed with a cancer that is treatable but only by a very costly means? What do you do? Why are these meds so expensive?

An article from the Journal of Oncology Practice details the reasons for the high cost of cancer medications:

"First, pharmaceutical companies use a variety of strategies to delay or discourage competition by generic companies, for example "pay-for-delay" and "approved generics.

Second, as part of the Medicare Reform Act of 2003, and influenced by the pharmaceutical lobby, legislation forbade Medicare to negotiate drug prices. This, together with the Medicare expansion in 2006 to include prescription drug benefits, resulted in a financial bonanza to companies, clearly charted by the skyrocketing profits since 2006.

Third, the Patient-Centered Outcomes Research Institute (PCORI), which evaluates treatments for coverage by federal programs, is prevented from considering cost comparisons and cost effectiveness in its recommendations. Such mechanisms, which emphasize value and price, rebalance the legitimacy of the purchaser and patient perspectives by diminishing their position as passive price takers.

Fourth, US laws forbid the importation of prescription medicines from abroad, even for personal purchases. The purported reason (supported by the pharmaceutical lobby) is patient safety.18 However, in the latest estimates of the Canadian government's Patented Medicine Prices Review Board, as of 2011, US consumers pay 100% more for patented drugs than elsewhere."

The President's Cancer Panel concludes; "that when it comes to defining the value of cancer drugs, patients' benefit must be the central focus. When patients' finances are strained, they are less likely to follow treatment regimens, potentially worsening health outcomes the drugs are intended to improve. The term "financial toxicity" describes the negative impact of cancer care costs on patients' well-being. Like medical toxicities caused by cancer treatment, financial toxicity can impose a significant burden on cancer patients. Rapidly rising spending on cancer drugs is unprecedented and cannot be ignored, and that public-private collaboration is critical to ensure that patients receive high-quality cancer treatment and experience the best possible health outcomes without financial toxicity."

Some of the suggestions from the Panel include:

• Enable communication about cancer treatment options and include information about cost
• Stimulate generic and biosimilar competition
• Ensure adequate resources for the FDA
• Invest in biomedical research

So, where do our patients stand? Its seemingly up to us, as nurses to provide some of this education. Its not enough that providers and physicians prescribe, but we must all be mindful of the cost.

[SpankedInPittsburgh, DNP, RN]

I'd probably buy groceries as starvation will usually kill you quicker than cancer. However, this is an incredibly poor choice that Americans shouldn't have to make. If we can fund a multi-decade ill-fated, going to nowhere misadventure in the middle east costing untold billions we should be able to help our fellow citizens avoid such a choice even if it means giving up our role as world policemen.

[KelRN215, BSN, RN]

People with end stage renal failure automatically qualify for Medicaid because they will die without dialysis. I don't understand why a cancer diagnosis doesn't automatically qualify a patient as well. Doesn't make sense to me

People with ESRD qualify for Medicare. I have seen children as young as 2 on Medicare because of dialysis. It's a giant pain in the rear too when they need things like tube feedings because Medicare criteria is not designed for children.

End-Stage Renal Disease (ESRD) - Centers for Medicare & Medicaid Services

Medicaid qualifications vary by state. In my state, children with cancer qualify for secondary Medicaid based on diagnosis. Depending on the family's income, they may have to buy into it. I have occasionally had pediatric oncology patients who came from high income families (like in the mid-6 figures) whose families decided it wasn't worth the cost for the extra coverage because the Medicaid would cost more than their OOP costs with their primary insurance.

I want to say in my state breast cancer and cervical cancer are automatic qualifications for Medicaid.

[Buckeye.nurse]

Thank you for clarifying KelRN! You are right that dialysis patients get *Medicare*, and not Medicaid. Oops! All that aside though, the OP brought up a huge issue that many of our patients struggle with. My place of employment has fantastic case managers who try to find our patients grants, sliding scales, vouchers, and other means of assistance for paying for their care. Sometimes though, cost determines what treatment options patients choose. It frustrates me when I see commercials for the on body Neulasta, for example, and the commercial encourages people to "talk to their doctor". Almost every single one of my patients would love to use that product, but some insurances won't cover it.

Thanks again for the article OP. Here's a link to a study the American Cancer Society did related to cancer care costs: https://www.acscan.org/sites/default/files/Costs%20of%20Cancer%20-%20Final%20Web.pdf

[KelRN215, BSN, RN]

Those neulasta commercials drive me crazy too. For kids it's even worse because the littles only need like 1 or 2 mg and it's only available in a 6 mg syringe that costs something like $7,000. And where I used to work, the Case Managers would go crazy trying to find an infusion pharmacy that's willing to waste the majority of the syringe and pre-draw it for the families because they don't think families can be taught to measure out 0.1 or 0.2 mL of it and then the pharmacies don't want to do it because of cost.

[Neats, BSN]

I am late to this thread but will comment and some of you may not like it....

I grew up in Canada (Yukon Whitehorse), I have lived in Germany for 6 years even having twin boys there.

I have always worked in the medical arena both as an administrator and as a nurse and this is what I see...

We in the USA, have not decided if healthcare is a citizen right or commodity (money maker and service) much like any other service industry i.e. McDonalds or for that matter your local DME business.

There is no standard to medical care with exception of regulation/policy/procedure.

There is no standard to medical care documentation (I place this separate from above) as this makes a huge difference in cost and quality of cares.

There is fundamentally a benefit for pharmaceutical companies to bring to market new medication, per our Food and Drug Administration Laws this is very costly. This process has benefitted the companies but their capital layout is in the millions seeking the best chemical compound for a patient for a specific disease. They need to recoup their monies back and make a profit. What they do not need to do is make a killing on it i.e. epi pens-this is just pure corporate greed but America is capitalism meaning we choose the free market and competition. What this has resulted in is many innovated technology, medical, engineer and "intellectual" expansions that have benefited the world. No other country has ever had such a huge impact on the world, only the USA. Other countries have made impacts and still do but not on the scale of the US until the last 20 years.

What could have been so special for the USA...some sort of basic healthcare national coverage that focuses on preventive services and a catastrophic coverage for those serious and multiple medical chronic conditions have come and gone with the Affordable Care Act (ACA). Government had to place their pork barrel fat and "wisdom" of policy making and unfortunately the medical community professionals did not raise a stink about the plan content.

This plan needs to be reduced in order for the American taxpayers to afford this. This (ACA) plan needs to have restrictions on services in order to pay for this. This plan needs to have incentives for those who take care of themselves verses those who do not (barring those who cannot for multiple reasons).

When the ACA plan was initially started many people came out of the shadows and received the care they so needed but could not afford, now they cannot afford because the co-pay/deductible is too high. We are back where we started. If we focus on preventive in the first place, teach about health from the beginning of a persons life and make it common place we will have much more success and health than being reactive. Being proactive takes monies.

Not all socialized healthcare overseas is good. Living in Canada I had long waits so much so my dad would come to the US for treatment. Living in Germany long waits too, You do not get the gold star treatment in ether country. You still need to pay for some services too. The pharmaceutical companies have different rules for overseas and the country in which they operate makes government decisions as to what they are willing to pay for medication. There are many medication people overseas do not get as it is unavailable, some is so common it is available and you just meet criteria to get it.

As a whole I much would rather live here in America where the hard work I do, the choices I make are mine to own. I do not want anyone telling me what I can get or not and price it on how much I earn. I think Americans need to band together an let our leadership know we want simple healthcare, simple catastrophic coverage and affordable medication. We just better be prepared to live with a decreasing market where medication development has slowed to a trickle, where my taxes will go up tremendously, and no more "salon spa like services" when I go top the hospital or for that matter my doctor office.

There is no easy answer but I do know where we are going is not sustainable and will eventually be placed in tough decision making situations of life or end of life cares at any age. There has to be a happy medium for us all with coverage and affordability. Both sides have to give not a little but a lot in order for our healthcare system to work.

Lastly my soap box about standardize documentation. Again the ACA should have mandated a national wide Electronic record for all health care services. This should be based on anatomy and Physiology and we in the medical field should have access to this as a security clearance. This way when your grandma comes to you for a visit and she has the need to seek medical care I as the ER nurse can look her up and see her last few episodes of healthcare interactions to include imaging/labs.

[traumaRUs, MSN, APRN]

@Neats - what a thoughtful answer - thanks for your comments.

I do agree the US medical system needs overhauling.

[Daisy4RN]

@Neats - what a thoughtful answer - thanks for your comments.

I do agree the US medical system needs overhauling.

I agree with both your statements. I worked in Oncology and saw many families suffer through not only the disease but how to pay bills, buy food etc. I was hopeful with ACA but it really didn't do that much. I think the whole system needs an overhaul too. Too many frivolous lawsuits, too many regulations etc., everything needs to be looked at and addressed or the problem remains. Just sad!

[AnnieNP, MSN, NP]

traumaRUs, I absolutely love reading your articles.

[Night__Owl, BSN, RN]

We need socialized medicine, plain and simple.

The long waits are a symptom of a healthcare provider shortage. Guess what? We have a HCP shortage too. The reason you don't have to wait months to have surgery is because there are a hundred people who are poorer than you who can't have surgery at all.