Why Cancer Patients Should Not Get Everything They Want
Christi Turnage (pictured), a cancer survivor, has started a petition to ask the FDA to maintain Avastin's status as a breast cancer drug even though an FDA advisory committee has recommended that designation be removed because Avastin's effect on breast cancer is minimal. Her 19-year-old son has produced a heartbreaking video urging folks to join the effort.
It's impossible not to appear cruel when arguing against cancer survivors, but here goes: America needs to have a grown-up debate about the price of drugs and their effectiveness. These drugs have the potential to bankrupt Medicare, strip coverage from the privately insured, and create perverse incentives for companies to develop more expensive, marginally effective drugs.
An insistence that all drugs should be paid for, regardless of the cost, is scientific illiteracy. Not all cancer patients should receive free of charge (or rather, at the taxpayer and premium-payer's expense) every drug they want. Yet that is the exact argument Turnage's son is making. His video asks:
But is this clinically meaningful for patients? ... I would say yes. A day, a week, months or in my mom's case ... even years of progression free survival are definitely worth it.I disagree. A single day, a few weeks, even a month or two for someone dying of cancer -- and all the horrors that entails for the patient and the family -- is not worth $50,000 a year if you're asking someone who isn't the patient to pay for it.
Let's put this in perspective in terms of the burden tax and premium payers are being asked to carry when it comes to super-expensive or marginally effective drugs:
- Roche (RHHBY)'s Avastin costs $50,000 a year, yet the drug shows no survival benefit in breast cancer patients. The FDA has yet to make a final decision on Avastin's breast cancer indication.
- Dendreon (DNDN)'s Provenge costs $93,000 a year, and although it shows some improvement in survival for cancer patients it appears to have no effect on the progression of cancer itself. (The Centers for Medicare and Medicaid Services has scheduled a Nov. 17 meeting to determine coverage for Provenge.)
- Alexion Pharmaceutical's Soliris, costing $409,500 a year, is the world's most expensive drug. It's a monoclonal antibody for a rare immune system disorder that destroys red blood cells at night.
- Allos Therapeutics (ALTH)'s Folotyn treats a rare lymphoma and costs $30,000 per month.
- Roche's Tarceva extends survival two weeks in pancreatic cancer and one month in lung cancer.
It's important to remember that if a drug is approved by the FDA then Medicare is literally unable to refuse to pay for it or negotiate the price of it. The government must insure all who qualify, come what may.
The ability of drug companies to drive the cost of their drugs up to $1 million a year without meeting any resistance from reimbursers could bankrupt Medicare. Private insurers can raise premiums (and thereby carve out the patients who cannot afford them) or simply drop coverage. In both scenarios, a majority of patients end up with less coverage while a select few end up with lavish drugs that may not actually work.
This is why some doctors are starting to argue that the current system encourages companies to create mediocre drugs. Why look for the cure for cancer when a marginal treatment is so much more lucrative?
(Incidentally, it also explains why companies like Novartis (NVS) end up paying charities for the blind to put out misinformation about the true cost of alternative uses for cancer drugs.)
The law needs to be changed. Medicare needs to have the same power as a private insurer to negotiate the price of drugs in the free market. To keep it handcuffed is to drive it toward failure (which, arguably, is what some people actually want).
Related: