Trend Toward New Oral Cancer Treatments Provides Challenge For Patients, Physicians

Main Category: Cancer / Oncology
Also Included In: Health Insurance / Medical Insurance;  Public Health;  Pharmacy / Pharmacist
Article Date: 16 Apr 2009 - 6:00 PDT

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A trend toward using new oral cancer treatments instead of traditional intravenous delivery is challenging for some patients, who could face difficulties in paying for the drugs, and physicians, who are forced to adjust to new roles in cancer care, the New York Times reports. According to the Times, oral cancer medications "are the new wave in cancer treatment" and are "a step toward making cancer a manageable chronic condition." Oral treatments, which currently account for less than 10% of all cancer medicines, are more convenient for patients because they require fewer trips for IV treatments, which in turn results in less health care spending. As a result, the oral medications are expected to account for 25% of all cancer medicines within a few years, according to the Times.

However, switching from traditional treatments to oral treatments is a "lopsided trade" for many patients because "the economics and practice of cancer medicine have not caught up with the convenience" of the new methods. Traditionally, cancer patients visit clinics and hospitals on a regular basis to receive IV drugs. The treatments are almost always covered by insurance and cost patients little out-of-pocket. However, a "double ledger of drug insurance" exists because IV drugs that are given at clinics and hospitals are usually covered by insurance as a medical benefit but the new pills are usually covered by prescription drug plans, "which are typically much less generous" in coverage, according to the Times. As a result, people with cancer could face large copayments or quickly exceed their annual coverage limit, the Times reports.

The Times reports that oral cancer treatments "seem to be causing a disproportionate number of financial problems for cancer patients." Some patients have been reducing dosing amounts or skipping doses altogether in order to make their medication last longer, according to the Times. In addition, some patients are opting for the IV treatments to reduce costs, the Times reports. Patients in the future could encounter fewer choices because some drugmakers that are developing oral versions of the IV drugs have stopped making the IV versions, according to the Times.

The shift from outpatient care, required by IV treatments, to at-home treatment "is also thrusting patients and doctors into new roles they have not yet fully mastered," the Times reports. Physicians now must rely on patients to take the proper dosage of their medications at the correct time and trust that patients are reporting all possible side effects, the Times reports. In addition, the shift "pose[s] financial challenges" to physicians because they are not compensated for writing a prescription but are paid for an outpatient treatment, the Times reports.

According to Carlton Sedberry, a pharmacy expert at Medical Marketing Economics, with oral cancer drugs, "the technology has outstripped the ability of society to integrate it into the mainstream in a smooth fashion." Some lawmakers have stepped in to address the challenges. Oregon has passed a law requiring insurers to provide equivalent coverage of oral and IV cancer drugs and several other states are considering similar statutes, the Times reports (Pollack [1], New York Times, 4/15).

In related news, the Times on Wednesday examined how the shift from IV treatments to oral medications is reducing physician visits and, as a result, lowering physicians' earnings. The piece also examined how oral cancer treatments might be costing physicians more than the IV treatments (Pollack [2], New York Times, 4/15).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

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