Cancer-Drug Costs Skyrocket, Leaving Even Insured Patients In Financial Ruin

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by Tyler Durden
Saturday, Jun 22, 2024 - 01:20 PM

Authored by George Citroner via The Epoch Times (emphasis ours),

An increase in cancer cases is putting pressure on Americans already facing a difficult situation—exorbitant drug prices, a lack of regulation, and a system that seems designed to profit, according to experts.

(Artem Oleshko/Shutterstock)

With medical debt burying patients, the battle against cancer is taking a new financial front that could bankrupt many cancer patients.

Emerging Patterns in Cancer Data

For more than seven decades, cancer has remained among the top two leading causes of death. Well over one-third of the U.S. population will confront a cancer diagnosis during their lifetime, according to National Cancer Institute estimates.

A new study published in JAMA Network Open analyzing cancer data from 3.8 million patients reveals a trend—Generation X, those born between 1965 and 1980, is experiencing a sharper rise in cancer rates across major types than any previous generation dating back to 1908. This trajectory suggests that elevated cancer incidence in the United States could persist for decades to come, representing a looming public health crisis.

The cancer mortality rate in the United States has consistently fallen year over year since 2000, but the rate of newly diagnosed cases is rising. In 2024, over 2 million new cancer cases are projected in the United States, according to data published in A Cancer Journal for Clinicians. This is up from 1,958,310 new cases in 2023.

The incidence rate for six of the top 10 cancers is also increasing. Incidence rose annually by 0.6 percent to 3 percent between 2015 and 2019 for cancers like breast, pancreas, prostate, liver, kidney, and HPV-related oral cancers.

‘Early-Onset Cancer Epidemic’

Research published in 2022 points to an “early-onset cancer epidemic.” Some evidence suggests a 79.1 percent global increase in early-onset cancers from 1990 to 2019 and a nearly 30 percent rise in related deaths.

While the causes are unclear, scientists suggest accelerated aging due to factors like diet, lifestyle, and environmental exposures may play a role.

A 2024 report shows younger adults as the only age group with increased overall cancer incidence from 1995 to 2020, rising 1 percent to 2 percent annually. Breast, prostate, endometrial, colorectal, and cervical cancer rates are also increasing in this population.

Young adults saw a 1 percent to 2 percent annual increase in cervical (ages 30 to 44) and colorectal cancers (under 55) between 2015 and 2019. Colorectal cancer rose from the fourth leading cause of cancer death in the late 1990s to the first in men and second in women under 50.

The Rising Financial Toll

As more cancer diagnoses loom over younger, working-age Americans, those affected face financial problems due to the skyrocketing costs of life-saving treatments.

Many cancer patients and survivors are drowning in medical debt despite having health insurance, according to a recent survey from the American Cancer Society’s Cancer Action Network.

Forty-seven percent of over 1,200 cancer patients and survivors surveyed have accrued debt due to their cancer treatment, with 49 percent carrying a burden exceeding $5,000. As many as 69 percent have been grappling with this debt for over a year, and more than a third (35 percent) have been saddled with cancer-related debt for three years or longer.

Almost all (98 percent) of these respondents were insured when the debt was incurred, with high-deductible health plans without a health savings account being the most common coverage (34 percent).

The findings suggest that those burdened with cancer-related medical debt are three times more likely to fall behind on recommended cancer screenings (18 percent versus 5 percent). Twenty-seven percent have gone without adequate food, while another 25 percent have been forced to skip or delay essential care due to the crippling debt.

Drug prices have been increasing, far outpacing inflation, according to a recent report prepared for the American Hospital Association by Healthsperien, a public health consultancy. While inflation was approximately 6.4 percent from January 2022 to 2023, the average price of cancer drugs increased by 15.2 percent in 2023 and 32 percent the year prior.

The median price for treatment for oncology drugs averages $257,000 per year—3.7 times higher than that of non-oncology drugs. Compounding the issue, the average inflation-adjusted launch price for oral cancer drugs increased by over 25 percent between 2017 and 2022.

If these trends persist, the average new self-administered cancer medication could potentially cost over $300,000 per year by 2025, exacerbating the financial burden on patients and straining health care resources, according to the report.

Health Care System’s Role in Drug Pricing

The overall health care system is to blame for exorbitant drug prices, Pavani Rangachari, a professor of health care administration and public health at the University of New Haven, told The Epoch Times.

The lack of price regulation and negotiations in the U.S. system allows pharmaceutical companies to enjoy “free rein” in setting prices, even for drugs with minimal benefits in prolonging life, such as those extending survival by only three or four months, she added. Patients could accumulate over $150,000 in costs for certain cancer drugs within that short timeframe, Ms. Rangachari noted.

While the high costs associated with drug development from “bench to bedside” contribute to the problem, pharmaceutical companies essentially hold monopolies due to patent protection, enabling them to maximize profits, she added.

The companies can also partner with providers and physicians and incentivize them to continue prescribing expensive drugs, Ms. Rangachari said.

Adding to the problem is the nature of cancer treatment itself, where patients often require multiple sequential drugs, and the burden of medical debt persists even as they transition to new medications.

A Medical System in Need of Reform

The problem with expensive cancer drugs is a systemic issue that demands government intervention through value-based purchasing models, Ms. Rangachari said.

These alternative payment systems allow states to negotiate lower drug costs with manufacturers, who should also be required to demonstrate the cost-effectiveness of their cancer treatments, as is the practice in other developed nations through value-based pricing tied to health outcomes and quality-adjusted life years.

However, the burden does not solely rest on pharmaceutical companies. All stakeholders, including cancer centers, must increase transparency for cancer patients, as the financial hardship for them extends beyond just medical costs to indirect factors like lost productivity.

Despite the current system’s flaws, some cancer centers have begun screening for financial distress among patients and offering services to help them. “That can make a big difference,” Ms. Rangachari said. Insurers can alleviate the strain on patients by reducing prior authorization requirements, considering off-label drug uses, minimizing coverage restrictions, and lowering out-of-pocket maximums, she added.

Ms. Rangachari emphasized the unsustainability of the current system, with insurers potentially being the biggest losers due to premium pricing issues stemming from the high variability in drug costs. She questioned how insurers could set premiums amidst pharmaceuticals’ unpredictable pricing, highlighting the risk of high expenses burdening patients unfairly.

There will likely be pushback from powerful entities as the Centers for Medicare & Medicaid Services (CMS) implements value-based pricing, Ms. Rangachari noted. “So the government has to gear up for a big fight.”