February 10, 2009

Cancer Drug Cost May Be Unbearable, Even for Insured

Cancer doctors may be writing the prescriptions for new generations of drugs, but some financially hard-pressed patients are not having those prescriptions filled.

The trend is worsening, according to Marilyn Stebbins, PharmD, health sciences clinical professor of pharmacy at UCSF. Stebbins, the pharmacy utilization director for Mercy Medical Group at the CHW Medical Foundation in Sacramento, has for 13 years been helping uninsured and underinsured patients find and navigate programs that can fill the financial gap.

“Over the past three years, our referrals from oncology have increased dramatically due to the high cost of many of these drugs,” she says.

It is not unusual for pharmacy bills to top $50,000 per year for cancer patients. “There are people who will just not start therapy until they come to see us to find out if there is any assistance,” Stebbins says.

Stebbins is not only referring to the most impoverished cancer sufferers, although they are clearly affected. She also helps many people who already have health insurance.

Among the elderly, who are so often stricken with cancer, it’s the federal government’s Medicare program that fails to adequately relieve the cost, especially for patients who rely largely or solely on Social Security for their incomes.

“These are fixed-income individuals. Even if they receive what they consider to be a reasonable Social Security check, a single drug might still cost them as much as $800 per month,” Stebbins says.

Part B of Medicare’s drug benefit includes a 20 percent co-payment, whichs mounts rapidly for the newest cancer drugs. Medicare Part D drug coverage is more complicated, but also features a costly gap. Not only in-office injectable drugs, but also several costly oral cancer drugs fall under part B coverage, Stebbins notes.

While many older chemotherapy drugs are available in cheaper, generic form, an increasing number of expensive, targeted therapies are becoming part of standard cancer treatment after having been shown to prolong life an average of a few months or more – sometimes much longer in clinical practice for certain patients.

Stebbins uses the example of a patient with a common form of lung cancer as an example. A new, targeted cancer therapy, Tarceva, may cost $3,900 per month. If the patient gets anemia, he or she may require Epogen, a $550 charge. If the patient loses too many white blood cells, the order of the day may be the immune booster Neupogen, priced at $2,600 for five days of treatment.

“Even someone fully insured through Medicare would still have tremendous out-of-pocket costs,” Stebbins says.

Stebbins guides patients through the use of resources that are available online or through a toll-free telephone number to providers, as well as to patients, but that can be difficult to navigate.

For patients without any health insurance, pharmaceutical companies may make drugs available for free. Stebbins refers patients to the pharmaceutical companies’ patient assistance programs, which have requirements and forms that vary from drug to drug. Patients with health insurance, even if it is inadequate, do not qualify for this form of assistance, according to Stebbins.

For underinsured patients, Stebbins favorite go-to is the more user-friendly HealthWell Foundation, a nonprofit organization that can help pay not only for drugs, but also for physician care and other costs. But there are other resources too.

The high cost of cancer, if not satisfactorily addressed, has certainly not gone unnoticed in health policy circles. Just last week saw the release of a report by researchers at the Kaiser Family Foundation and the American Cancer Society, entitled “Spending to Survive: Cancer Patients Confront Holes in the Health Insurance System.”

Also last week, a study presented at the American Association for Cancer Research conference “The Science of Health Care Disparities” found that an estimated 1 million Americans go without recommended cancer treatment. Hispanic and African American paients are particularly vulnerable, the researchers discovered. And finally, last week, the San Francisco Chronicle published a story highlighting the bankrupting cost of cancer care, and listed several resources for patients.

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