President Trump’s long-awaited plan to reduce the costs of prescription drugs calls for a comprehensive set of reforms, including redesigning the patent system to prevent drug monopolies, uncloaking the role of pharmacy benefit managers, and charging foreign governments more for brand name drugs. He also proposed bringing more negotiation tactics into Medicare Part D and Part B, which cover most cancer therapies.
In the abstract, these approaches seem to make sense. But as oncologists, we see how they play out in the clinic and how they affect patients. While we support an effort to bring value across the health care ecosystem, the president’s plan needs to go further to help people with cancer.
Major advances in cancer genomics and targeted treatments are transforming the way we treat cancer. People with it are living longer and better lives, making it absolutely essential that each one receives the best treatment for him or her. We urge the president and Congress to take definitive action against the ever-increasing cost of cancer therapy in particular.
In a hearing last week, members of the Senate Committee on Health, Education, Labor, and Pensions took aim at the 340B drug discount program, which many cancer centers rely on to deliver cancer treatment to the underserved. Senators called into question whether hospitals were using the savings generated by 340B on charity care. At our centers, the Henry Ford Cancer Institute and the Sylvester Comprehensive Cancer Center, we treat many uninsured and underinsured patients, often without payment. The 340B program allows us to buy expensive cancer therapies at a discount and provide them to those who need them but can’t pay for them. The program has long been overdue for an update to add mechanisms for oversight and accountability, but eliminating it is not the solution.
Containing costs for exorbitantly priced therapies is another must-do item. But we need to make sure any cost savings are passed directly to patients. We are encouraged by the administration’s efforts to minimize the role of middlemen like pharmacy benefit managers, who often interfere with treatment decisions to minimize cost.
No patient should have to make a decision about his or her care based on the price of treatment. To that end, we recommend a three-pronged approach to the Trump administration’s plan:
Pay for value. We need to accelerate the push toward value-based drug purchasing. Patients should not have to pay high out-of-pocket costs for treatment, especially if it doesn’t work. Payment for cancer therapies should vary based on the outcomes they produce. As additional expensive targeted treatments become available, we will need solutions to ensure that patients receive the right drug for them. Reforming the drug supply chain around value will be a fundamental first step.
More collaboration. We need to provide incentives for everyone involved in cancer care to work together, including hospital systems, providers, payers, drug manufacturers, and government. By learning from each other’s expertise, we can create a better system. Our cancer centers joined forces with several other health systems to share real-world outcomes data in Syapse’s Data Sharing Network. Together we are generating powerful insights into which treatments produce the best outcomes for which patients, information that can inform real-time treatment decisions, payer coverage policies, and investments in pharmaceutical research and development.
Better support. We also have to support patients fighting cancer and the health care providers who work with them. We would like to see substantially reduced patient cost sharing for high-priced therapies. Many patients stop treatment because they can’t afford the next copay, eliminating their chance for remission and creating larger downstream costs. Clinician support is also essential. By helping clinicians understand which tests or treatments to administer for a patient with certain genomic characteristics, we can minimize variation in care, reduce waste, and ensure that patients receive the right treatment at the right time, an effective approach demonstrated by Intermountain Healthcare.
The U.S. health care system needs to strike what may be seen as a contradictory balance: sustain the rapid rate of innovation in medicine while making health care less expensive. Properly addressing the cost of cancer therapies will demand a coordinated effort from clinicians, researchers, and lawmakers.
Next week, the oncology community will convene at the annual meeting of the American Society of Clinical Oncology to learn about the next wave of new, and potentially expensive, cancer treatments. While the debate on the cost of cancer drugs remains contentious, there has never been more reason to hope for successful treatments, perhaps even cures, for cancer given all the advances we have made in treating this dreaded disease. But we won’t fully realize the promise of these innovations unless we act now to create access to affordable treatments, stimulate additional research, and put our patients first.
Steven Kalkanis, M.D., is chair of neurosurgery and medical director at the Henry Ford Cancer Institute in Detroit. He is a consultant for Synaptive Medical and Arbor Pharmaceuticals. Jonathan Trent, M.D., is professor of medicine and director of sarcoma at the University of Miami Sylvester Comprehensive Cancer Center. He is on advisory boards or panels for Eli Lilly, Janssen, Bayer, and Blue-285.