Drug Costs and Medicare

Not everyone with cancer has Medicare, but all of us are affected by Medicare rules. Since 1.7 million new cancer cases were diagnosed in the US in 2016 (!) and since the median age of those new patients was 65, it is clear that many people are going through Medicare-covered cancer treatment. The issue at hand is that Medicare does not automatically cover all new cancer drugs, especially not all new expensive cancer drugs. And other insurance carriers frequently take their cues from Medicare.

This is a wonky but extremely important editorial from the Journal of Clinical Oncology:

Cancer, Financial Burden, and Medicare Beneficiaries

Cathy J. Bradley

In the absence of altering price negotiation and mandatory coverage policies, the Centers for Medicare and Medicaid Services proposed reforms to counteract high prescription drug prices.   These reforms include incentivizing best clinical care (meaning choosing lower-cost, clinically equivalent or better treatment options), indication-based pricing, reference pricing, and risk sharing on the basis of outcomes. A common feature of these approaches is that they shift the pressure to physicians to reduce costs by making value-based prescribing decisions. This may be impractical, given that the research and clinical practice community operates without adequate or readily accessible evidence to make these decisions, despite many attempts at distilling oncology cost and benefit information in an efficient manner that is understandable to both physicians and their patients.   Without evidence, physicians may not be aware of low-value prescribing practices and are unable to appropriately counsel patients on how to make a value-based decision.

Read more (this is an excerpt): http://ascopubs.org/doi/full/10.1200/JCO.2017.73.1877