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Financial Toxicity, Part I: A New Name for a Growing Problem
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The Politics of Medicare and Drug-Price Negotiation (Updated) http://bit.ly/2s1X7ox |
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Financial Toxicity of Cancer
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Financial Toxicity and Cancer Treatment (PDQ®)—Health Professional Version -
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The High Cost of Prescription Drugs in the United States:
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Cancer Drug Pricing and Reimbursement: Lessons for the United States From
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2016: New Immunotherapy Costing $1 Million a Year http://wb.md/2aEqZfA |
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Health secretary wants to transform how doctors and hospitals get paid - LA Times http://lat.ms/2aXevB7
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Dr. Saltz: The Value of Considering Cost, and the Cost of Not Considering Value http://bit.ly/1OqLOWz |
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WSJ: Push Ties Cost of Drugs to How Well They Work http://on.wsj.com/1GEYvhm
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"10% of patients abandoned their anticancer medicine, and another quarter had some delay in initiating another oncolytic." 12
See for an Action Item -- an easy way to discuss with your elected representative: Advocacy
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NEJM:
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Map of States with oral parity laws:
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PEAC | Myths & Facts about Chemotherapy Parity & The Cancer Drug Coverage Parity Act http://bit.ly/1gtSec4 |
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Oral Parity Update: It’s Time for Congress to Act | ACCCBuzz http://bit.ly/1oUsAOS |
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KHN: Some states mandate better coverage of oral cancer drugs http://bit.ly/1gienJx |
When the pharmacist called to tell Adler his plan had approved him for the drug, she asked how he wanted to handle the charge of $3,200. That amount would cover the 50 percent coinsurance he owed for the first three-week cycle of 21 pills, after which he would take a week off and then start the process all over again
Adler, who used to own a stationery store and has an individual policy, couldn't believe it. "No, it must be $320," he remembers saying. Adler's out-of-pocket costs, after 13 cycles of the drug, were $42,000. Family members helped pay.
Under an oral oncology parity law, his situation would probably have been quite different. The out-of-pocket maximum for the medical benefit part of his policy is $3,500. "It would have cost me $3,500 for the whole year instead of $3,000 for one month."* Medscape, 2013:
Abolishing High Co-pays for Oral Chemotherapy: Why Is a Federal Law Needed? http://bit.ly/ONFsJI* News Article : More Assistance Programs to Accept Medicare Beneficiaries http://bit.ly/1cfCwL0
Relevant to current concerns about high out of pocket costs for on-patent cancer drugs:
BETHESDA, MD, 12 May 2006—A growing number of drug manufacturers are rethinking their decisions to bar Medicare beneficiaries from patient assistance programs (PAPs).
The AstraZeneca Foundation announced Wednesday that its assistance programs are now open to all Medicare beneficiaries who meet financial and eligibility criteria. The programs had previously been closed to Medicare beneficiaries who had enrolled in a Part D prescription drug plan.
Also this month, two companies—GlaxoSmithKline and ELi Lilly— announced that qualified Medicare beneficiaries who do not sign up for a Part D drug plan can enroll in the companies' assistance programs. Both companies had previously stated that all Medicare beneficiaries would be ineligible for the programs.
* ASCO Answers: Managing the Cost of Cancer Care http://ow.ly/tjnGz
Includes Financial resources.
5 years ago today, we released the first edition of our booklet for patients and caregivers on managing the cost of care. And, it’s gone through several updates since then, including for 2014! Get our new update of “Managing the Cost of Cancer Care” (PDF).
* Unsustainable prices of cancer drugs: from the perspective of a large group of CML experts - bloodjournal.hematologylibrary.org: http://bit.ly/1b2fx9d
The doctrine of justum pretium, or just price, refers to the “fair value” of commodities. In deciding the relationship between price and worth (or value), it advocates that, by moral necessity, price must reflect worth. This doctrine may be different from the doctrine of free market economies where prices reflect “what the market bears,” or what one is willing to pay for a product.
Patients with life-threatening disease have immediate worries but increasingly we must worry about receiving timely access to quality health care services - and if we can pay for it.
Can we pay our rent and the copayment for the oral drug we need?
Can we afford to receive an expert second opinion - or find a specialist with an opening within a month?
Can we make the payment on our insurance premium if they continue to rise? Will our doctor be able to see us in a timely manner when our condition changes? Must we wait months for the test that determines our fate .. and longer to learn of the result? Are the monopoly-based prices for cancer drugs under patent protection ethical, just or sustainable?9
The health care system is growing in complexity - rapidly, driven by what has been called "disruptive technologies - the ability to test and treat disease in very expensive new ways. The complexity of our medical system also contributes to medical errors, which harms patients directly of course, but also financially.2
Increasingly in clinical research, there's a need to consider and test how to do as well or better with less treatment and tests if we are to avoid breaking a system that is already financially stressed by rising demands - the increasing age of the population that will lead to more cases of cancer.
The Affordable Care Act can help to distribute the financial burden and risks by increasing the pool of patients who pay into the system - but insurance reform (including limiting the profits of the providers -- 80-20 rule) will not be enough. The ACA includes programs to help to reduce costs (such as prevention coverage, and funding to explore new payment models) but ACA alone cannot address the primary forces that threaten access to quality healthcare.
The primary forces that threaten access to quality healthcare:
There's a need to address the affordability of new drugs1 - to find the right balance in patent law so that it retains incentives to innovate without limiting access to the patients the product was developed to help. Patent law must serve the public interest.
There's a need to address what has been called a perverse incentives (fee-for-service payment) to over-test and over-treatment; and to contain hospital care costs which is the leading driver of rising health care costs. 1
There's a need to plan for increased demand due to the aging of the US population1 ... to find ways to provide more efficient high quality care (to do better with less).
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The cost of the drug based on efficacy. The patient pays less if the drug is not effective for them. |
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Patent law / approvals: requires companies to provide drugs for NIH-funded comparative effectiveness testing. |
Dr. Saltz: The Value of Considering Cost, and the Cost of Not Considering Value http://bit.ly/1OqLOWz