Improving access to cancer drugs

Dr. Philip Stella

When it comes to fighting cancer, Michigan patients need to access a wide array of treatment options. Unfortunately, many therapies are currently unavailable to dangerously ill individuals across our state.

That is why the members of the Michigan Society of Hematology and Oncology and the American Society for Clinical Oncology back a crucial state policy change. Senate Bill 625 opens the door to important oral chemotherapy treatments that can serve as lifesaving tools for remission and recovery.

In recent years, groundbreaking new treatments have become available to people fighting certain types of cancers. Many of these treatments come in pill form, providing intriguing alternatives to traditional intravenous or injection therapies.

Oral cancer drugs play an increasingly important role in my day-to-day care of cancer patients. Sometimes oral medications represent the only or best treatment option, making them a non-negotiable part of a thoughtful plan of care.

While the new treatments represent new hope for cancer patients, the news is not all good. Many patients are finding their health plans don’t cover oral chemo drugs in the same way they do more traditional methods of IV chemotherapy.

In fact, the co-pays for oral drugs may be thousands of dollars more than IV treatments. How a drug is delivered—through IV or by pill — should be irrelevant to how much patient has to pay. Ultimately, this is an issue of access to important new therapies.

For many patients, the cost of these essential pills is an insurmountable barrier to getting the treatment they need. They resort to an array of strategies — online fundraising, auctions or dinners, to name a few — that allow them to pay for their treatments out of pocket. In some cases, families are even willing to consider bankruptcy as an option, simply to purchase the treatments necessary to save the life of a loved one.

Why would a health plan pay for an IV drug and not for a pill? The facts are complex, but generally speaking the issue is whether the treatment is covered under the “medical” portion of a health plan versus the “pharmaceutical” part of the plan.

SB 625 would help ensure that similar policies apply to patient cost sharing for traditional intravenous cancer drugs and oral cancer drugs. Forty states and the District of Columbia have enacted similar laws. Michigan should be the next state to take this important step.

As a physician, I work carefully to map out an appropriate plan of care for each of my patients. Just as no two people are alike, no two cancers are the same — and each requires a customized approach capable of generating the best possible outcome.

Those outcomes become impossible to achieve, however, if I have to swap “best” treatments for “cheapest” treatments.

Cancer is an expensive disease that is projected to cost more than $157 billion annually by 2020. According to a recent survey by the Kaiser Family Foundation and the Harvard School of Public Health, 25 percent of respondents used all or most of their savings as a result of treatment cost, and 11 percent were unable to pay for basic necessities like food, heat or housing.

Let’s not compound the cost of cancer further.

Dr. Philip Stella is a physician in the St. Joseph Health System.