Anyone who cares about cancer patients should read Scott Gottlieb's article on Forbes.com. As Dr. Gottlieb sees it: "We're at a turning point in battling cancer. Doctors are finally able to reliably tailor treatments to the unique genetic composition of each patient's tumor rather than by its location in the body alone. Other new drugs are able to prime our own immune cells to attack cancers. But Obamacare puts access to this progress at risk." Health care reform "is going to degrade medicine but its ill effects will fall disproportionately on patients with serious conditions, especially those diagnosed with cancer."
Gottlieb sees three ways health care reform will endanger cancer patients:
First. It will "block the ability of patients to seek out the specialist doctors who are most likely to prescribe these cutting edge treatments."
Second. It will "coerce doctors to cut down on their use of costlier drugs and tests by changing the way that they're paid. The law uses "bundled" payments, where doctors get lump sums of money to care for patients with particular medical problems. The idea is to pit the cost of the treatments doctors prescribe directly against their earnings and give doctors a potent incentive to use cheaper remedies."
Third. It “targets cancer drugs directly, by expanding a program called 340B, which siphons money away from drug developers in order to subsidize hospitals.” (340B is the section of federal law requiring that new medicines and medical technologies be made available at a discount to the hospitals serving the poorest patients). But now the program is part of a scam. Rich hospitals use the program to pad profit margins. Worse, because hospitals are buying up oncology practices in droves, there’s an incentive to deliver care in hospitals. Gottlieb notes: “When cancer care to shifts to hospital clinics it’s not only less comfortable for patients, but also more costly. This wastes resources, making it harder to pay for the new technology that actually improves outcomes. Owing to hospital inefficiency, a patient treated in a hospital clinic costs $6,500 more than the same person treated in a private medical office. The cost of infusing the drugs alone rises by 55 percent.”
And there’s a fourth way patients are being harmed. As I have noted previously in an article called New cancer cures insurers won’t cover, health insurers are also jacking the cost to patients for the newest cancer drugs that turn off the source of tumor growth with fewer side effects. Patients are being faced with an awful choice: a) stay on an older drug that is less expensive and is covered almost completely by health plans, or b) use the targeted treatments that work best for them. Is it a coincidence that these policies are forcing doctors to use older infused cancer drugs that are less expensive to begin with (and even cheaper because of the 340B scam) driving hospital profits even higher?
Much of what Gottlieb describes was already taking place before health care reform was passed. Indeed, health plans have been using commercial firms that package this systematic rationing and market it as a patient-centered oncology pathway.
This borders on fraud. And it certainly harms access to medical innovation as noted specifically in two areas of this site, Progress & Prosperity and Personalized Cancer Care, which speak to reducing the cost of cancer care and increasing life expectancy.
Insurers need to be confronted about the barriers to cancer innovation
Can patients choose doctors and cancer centers that start by targeting treatment to individuals as well as variations of tumors? Are they forced to pay more for such precision care if they can? Are they forced to pay thousands for the medicines that targeted-treatment selection suggests? Are they forced into oncology pathways that encourage the use of medicines that give health plans the biggest margins? Or are the pathways tailored to individual differences and guided, not by short-term cost considerations, but by what diagnostic exams and genomic sequencing indicate will extend and improve the quality of life?
These were questions or benchmarks that cancer patients should have known about before health care reform was considered. We will produce a report card that rates health plans according to how innovative and patient-focused they really are. As Gottlieb notes, we should be accelerating the virtuous cycle of innovation, not throwing up barriers to cancer survival.
Let’s face these hurdles together and continue to find ways to overcome them. Join the movement to keep medical innovation moving forward!