The new movement in cancer treatment is the use of pills and capsules. They are predicted to account for 25 percent of all cancer medicines in the next few years, an increase from fewer than 10 percent at the present. Patients can be freed from numerous trips to the clinic where they have to be hooked up to an intravenous line, sometimes for hours.
Unfortunately, switching from an IV bag to a pill is an unfair trade, since the economics and practice of cancer medicine has not caught up with the convenience of oral drugs. For instance, drugs that are used at a clinic are usually paid for as a medical benefit, such as surgery. Pills are typically covered by prescription drug plans, which are usually less generous for expensive cancer pills. Patients might have large co-payments or swiftly go over an annual coverage limit.
Sometimes a single insurer is involved. Often, a separate company, or pharmacy benefit manager, provides prescription drug coverage. The increasing use of cancer pills is also pushing patients and doctors into roles they have not been in before. Without the supervision from a physician, some side effects can be missed, and some patients don’t take all their medicine, increasing their chances for their cancer to get worse. Then, others can take too many pills, causing toxic reactions.
Carlton Sedberry, a pharmacy expert at Medical Marketing Economics, a consulting firm, said that “the technology has outstripped the ability of society to integrate it into the mainstream in a smooth fashion.”
The health reform debate in Washington has not yet gone into specifics such as cancer pill coverage.
Also, infused drugs can be terribly expensive and under some insurance plans, even Medicare, big co-payments are the result. The oral drugs, though, are the ones that seem to be causing the most financial problems for cancer patients. The Patient Advocate Foundation says that oral drugs accounted for 56 percent of cases in which it helped Medicare patients last year. This organization helps people make insurance co-payments for cancer drugs.
Some drug companies provide free drugs for some patients and give money to charities for copayment assistance. The senior vice president for oncology at the big insurer United Health-care, Lee Newcomer, said that many commercial policies capped total yearly out-of-pocket expenses, so that patients would not have large co-payments continuously. This said, many patients still have trouble paying for the drugs.
Even though pills and capsules are improving the life for some cancer patients, they are draining the finances of many cancer doctors.
Oncologists can make money for drugs that they administer in their offices, because they buy them at wholesale and get reimbursed, usually at a higher rate, by patients and insurers. they also get paid for administering the infusion.
On the other hand, with oral drugs the doctors just write a prescription that the patient fills at a pharmacy, so the doctors don’t make any money from the drug. Some doctors are even saying that the pills are even raising their operating expenses, because patients are calling nurses to discuss side effects and there is no payment for that. A lobbying group representing oncologists, called the Community Oncology Alliance, has started a project to measure the costs that occur when dealing with cancer drugs.
Some large oncology practices have opened their own pharmacies, so that they can get some of the profits from oral drugs. Many of these doctors say that it is mostly for patient convenience, since neighborhood drugstores usually do not carry cancer drugs, due to their expense and scarce usage by few customers.