Blog written by Patricia Goldsmith, CEO, CancerCare
We have all been affected by cancer in some way – whether through a parent, child, sibling, friend, neighbor or colleague. Recent progress in the research and development of novel oncology therapies has brought new hope to those living with the disease and their loved ones. Between 2000 and 2016, due to improvements in treatment, more than 1.2 million people in the U.S. were saved following a cancer diagnosis. Almost 50% of the total U.S. Food & Drug Administration (FDA) pipeline is for new cancer treatments and 27% of new drug and biologics approvals in the U.S. today are for cancer.
At CancerCare, we see the impact of these groundbreaking treatments on a daily basis. Cindy Bass was a patient advocate and a valued member of the CancerCareteam, and the longest living Stage IV non-small-cell lung cancer (NSCLC) survivor before she passed away in 2021. Following her diagnosis in 1997, Cindy was able to spend 24 years enjoying time with her loved ones, participating in her theater club and working with the CancerCare community due to medical innovation. The five-year survival rate for NSCLC is just 26%, yet recent advances in oncology treatments have enabled patients like Cindy to live longer and more fulfilling lives. Not only is Cindy’s story one of inspiration, but it’s an important reminder of the impact that innovation in oncology has on the lives of cancer patients and their loved ones. This is why we must protect the frameworks that enable us to bring new therapies and cures to those in need.
Bad actors across the healthcare system ─ including insurers and the pharmacy benefits managers (PBMs) that they own ─ have significant influence over the treatments patients can access, both in terms of increasing costs and limiting the availability of certain treatments in a patient’s formulary. More frequently, insurers and PBMs are instituting harmful policies that ignore the value of co-pay assistance or require patients to jump through hoops to access the medication that their provider prescribed. While patients with chronic conditions like cancer typically require long-term, continuous treatment to slow or prevent the progression of a disease, medicines to treat those conditions are most frequently excluded from PBM formularies. And far too often, the rebates provided by drug manufacturers to PBMs go directly to the PBM’s bottom line, rather than to helping patients pay less for their prescriptions.
Meanwhile, healthcare economics organizations, such as the Institute for Clinical and Economic Review (ICER), determine the cost-effectiveness of treatments and prescribe its findings as a potential solution to limit what patients pay for medicines. However, ICER’s findings are based on a fundamentally flawed and discriminatory methodology. In order to determine the cost-effectiveness of a drug, ICER utilizes what is known as the “quality adjusted life year”, or QALY. The QALY estimates the value of a treatment against a subjective standard of one year of “perfect” health. In effect, this framework places a lower value on a treatment that would extend and improve the lives of those who may have never been in perfect health, such as people living with cancer or a rare disease.
In our ongoing efforts to protect patients and educate about the harms of such bad actors, CancerCare has developed a toolkit for employers to help them understand the threats impacting treatment access for cancer patients. This is a critical first step to reaching out directly to employers and legislators to educate them on the issues that are threatening patient health outcomes.
Consider these figures: In 2022, experts estimate that 1.9 million cases of cancer will be diagnosed in the U.S. alone and that 609,360 people will die from the disease. We must work together to protect medical breakthroughs and ensure patients have access to the treatments prescribed by their doctors ─ so that patients can live longer and healthier lives.