Oral Cancer Drugs Deserve Parity

Margaret Dick Tocknell, May 25, 2011

Some cancer patients are walking away empty handed from the pharmacy because of the high cost of some medications.

A study linking the size of copayments to patient abandonment of oral cancer drugs released last week put a spotlight on the uncomfortable truth. Among the many findings: 25% of patients didn't purchase their prescription medication when they learned copayments or cost-sharing would require them to pay more than $500.

One of the drivers of high copayments is the high cost of cancer drug treatments. Medco Health Solutions has released a drug trend report that says cancer drugs are expected to see sharp increases in spending and use by 2013. More than 90% of cancer drugs approved since 2004 cost more than $20,000 for a 12-week course of therapy, that report says.

Another cost driver is the method that health plans use to provide coverage for cancer drugs. Chemotherapy is usually covered as part of medical benefit while oral cancer drugs are covered under pharmacy formularies and benefits. In general that means oral cancer drugs can be more expensive than non-oral chemotherapy treatments.

A few years ago, just when oral drugs were beginning to gain acceptance among physicians and patients, health plans began creating a specialty tier in their drug formularies for the expensive, biologic medications used to treat diseases like cancer. Oral cancer drugs found their way into this tier where the drugs carry significant copayments – often more than $100 – and may include cost sharing, which means the patients pays a fixed percent of the total cost of the drug.

Margaret Dick Tocknell Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.


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