American Patients Have Much, Much Greater Access to New Cancer Drugs Than Others Do
New research by scholars at the University of Pittsburgh shows how much better access American patients have to new cancer medicines than their peers in other developed countries:
Of 45 anticancer drug indications approved in the United States between January 1, 2009, and December 31, 2013, 64% (29) were approved by the European Medicines Agency; 76% (34) were approved in Canada; and 71% (32) were approved in Australia between January 1, 2009, and June 30, 2014. The U.S. Medicare program covered all 45 drug indications; the United Kingdom covered 72% (21) of those approved in Europe— only 47% (21) of the drug indications covered by Medicare. Canada and France covered 33% (15) and 42% (19) of the drug indications covered by Medicare, respectively, and Australia was the most restrictive country, covering only 31% (14).
(Y. Zhang, et al., “Comparing the Approval and Coverage Decisions of New Oncology Drugs in the United States and Other Selected Countries,” Journal of Managed Care and Specialty Pharmacy, 2017 Feb;23(2):247-254.)
I am no fan of the U.S. Food and Drug Administration, but it is a less restrictive bureaucracy than its counterparts in other developed countries. Allowing patients to use new medicines without the interference of a government bureaucracy should be pretty straightforward, as long as they are aware of the risks.
Coverage is more ambiguous. Both Medicare and other countries’ single-payers systems are socialized. So, we should not always jump to the conclusion that every approved drug should be covered 100 percent. As long as patients are free to pay out-of-pocket, we might not want taxpayers to pay the entire cost of each drug. However, cancer is the textbook diagnosis of a catastrophically expensive diagnosis, when we expect insurance to kick in. If insurance does not cover a wide portfolio of therapeutic options, it is not good coverage.
When we look at approval and coverage combined, the results are appalling. Of 45 drugs covered by Medicare, the British National Health System was the best of the other countries measured, and it covered only 21 – less than half. We are not talking about North Korea, here. Nevertheless, it is shocking how much citizens of otherwise free countries give up when they allow their governments to control their access to health care.
The two issues here are efficacy vs. alternative therapies already in the market and cost vs. those same alternatives. At some price, a payer has to and should refuse to cover a new drug. Suppose the drug company prices it’s new drug at $10 million for a course of treatment that might extend life by six months. Should we pay for it? I don’t think so. If a wealthy person wants to pay out of his own pocket, that’s great. Go for it.
Yes I also believe at some point health plans should have a right to say “no”. Just because they’re a big purchaser doesn’t necessarily translate into low prices. The only real bargaining power is refusing to purchase. Something like half of novel drugs approved last year were orphan drugs, most probably costing more than your house payment.
Devon, you are wrong. By contract the insurance company has to pay for the drug because it is a covered expense. There is a clause about experimental treatment but even then by contract you can take it to review. There is no clause that says “expensive treatment” is not a covered expense. Thank goodness you don’t sell health insurance Devon.
Barry, get real. You say I go to extreme when I say some employer-based health insurance plans cost $30,000 a year per family. Miami-Dade County employees’ PPO option cost is $42,000 a year. Then you come up with Rx costing $1.6 million a month and there is no such drug. Talk about EXTREME!
Barry, then you ask,”Should we pay for it? I don’t think so.” YOU have nothing to say about it, sorry. I had a doctor client with bone cancer and his insurance paid $2.6 million and he lived in a bubble for 6 weeks twice. YOU would say, “NO bubbles for you.” But, this is a contract between the insured person and the insurance company. You my good friend have nothing to say about it so thank goodness you will not be killing people to save a buck or two. It’s called health insurance Barry. It pays for an unforeseen claim or expense, remember?
You should get real, Ron. Haven’t you ever heard of drug formularies? No insurer covers every drug no matter what it costs just because it was approved by the FDA.
Barry, you have not read every insurance contract so don’t pretend you know something when you don’t. Sure, with your dangerous employer-based plans the contract keeps changing every year and your restrictions are now included. I had clients on 2000 contracts that did not have the restrictions that you say ALL INSURERS have. That is a LIE Barry.
By the way, to win FDA approval, a drug has to prove to be more effective than a placebo. It may or may not be more effective than competing drugs in the therapeutic class already in the marketplace.
Barry, that is the law, but when multiple studies are run where some studies are selectively ended it is quite possible a drug no better than a placebo might be approved.
Of course you are correct, Barry. We cannot afford to pay $10 million for cancer drugs treating a large population. But, when it comes to solutions you inhibit the marketplace that would naturally solve the problems of which drugs would be covered. Your solutions artificially trade one life for another and make those solutions political and more costly both in the healthcare sector and elsewhere.