Another salvo from oncologists over high cancer-drug prices

A commentary published in the latest Mayo Clinic Proceedings, signed by dozens of (mostly) academically affiliated oncologists, calls for a new effort to corral the prices of cancer drugs entering the market. The in-press article, "In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs" calls for patients and the public to sign a petition in hopes that “this quantified support can then be used by advocates, lobbyists and others to … encourage our elected representatives to more effectively advocate for … patients.” The physicians cite data indicating that the average price of new cancer drugs has increased 5- to 10-fold over 15 years, and the cost of drugs for each additional year lived has increased from $54,000 in 1995 to $207,000 (inflation adjusted) in 2013. Asserting that drug companies are “the sole decision makers on the price of cancer drugs,” the authors ask “whether current pricing of cancer drugs is based on reasonable expectation of return on investment or whether it is based on what prices the market can bear.”

Among the “simple and measured incremental actions” that government can take, the authors say, are:

• A post-approval review mechanism for drug pricing
• Allowing Medicare to negotiate drug prices
• Allowing the Patient-Centered Outcomes Research Institute (PCORI) to include pricing in assessments of treatment value
• Allowing importation of cancer drugs across borders (specifically, Canada).

PhRMA was quick to respond: in a blog post on the organization’s site, Robert Zirkelbach, SVP of communications, noted that cancer drugs represent 1% of overall US healthcare spending (and one-fifth of cancer therapy specifically); that 800 oncolytics are in development currently, and today, there are almost 14 million cancer survivors in the US. Most damning: the Mayo Proceedings authors ignore the price- and access-negotiating that insurers and pharmacy benefit managers conduct “aggressively;” the list price of many cancer drugs falls, depending on how the pricing contracts are negotiated. “The policy proposals they recommend would, if adopted, send a chilling signal to the marketplace that risk-taking will no longer be rewarded, stopping innovation in its tracks and halting decades of progress in cancer care,” writes Zirkelbach.

This argument has been going on for years; last month, the American Soc. of Clinical Oncology published a draft “value framework” to assess the effectiveness of oncolytics by a “net health benefit” that includes a cost factor. Back when the Affordable Care Act was first being written, PhRMA essentially became a supporter in return for the continued restriction of cross-border drug importation, among other issues. This standoff is cold comfort to cancer patients and their families exposed to high copays or co-insurance for the newest cancer drugs. But if nothing else, the article brings drug costs into more prominence as the next national-elections cycle begins to heat up.

It’s also notable that the roughly 1200-word Mayo Proceedings text was followed by 750 words detailing the “potential competing interests” of the signatories to the article and listing arrangements with a wide swath of pharma companies. Some will look on that as evidence of the problem with US healthcare costs itself; others will see room for reasonable debate even as the parties collaborate.