To Negotiate the Third-Party Payment Bureaucracy, Don’t Get Cancer

A growing number of patients are being denied access to newer oral chemotherapy drugs or are required to shoulder hefty out-of-pocket costs, sometimes thousands of dollars a month, for cancer pills with annual price tags of more than $75,000. The reason is rooted in a reimbursement system that covers IV chemotherapy as a medical benefit but considers less-invasive oral chemotherapy to be part of a patient’s drug plan, which tends to be far less generous. Some plans cap drug benefits at $5,000 annually, which can amount to less than a month’s supply of chemotherapy pills. The disparity is likely to affect increasing numbers of cancer patients, because 25 percent of 400 chemotherapy drugs in the development pipeline are oral.

Full article on expensive cancer drugs and treatments.

Comments (9)

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  1. Ken says:

    Hey, the patient might as well be in Britain or in Canada.

  2. Devon Herrick says:

    Considering the difference in reimbursement of intravenous oncology drugs versus cancer drugs in pill form, I’m surprised that drug makers even produce cancer drugs as tablets.

  3. Neil H. says:

    I think this is one huge argument for Health Savings Accounts.

  4. Virginia says:

    I agree with Devon.

    This seems like an arbitrary distinction to make, especially when the alternative to a pill is an IV. Is it really more expensive to manufacture the pill or it is that the insurance companies are trying to exploit the distinction? You would think that if a pill were less expensive, they would all be on board.

  5. artk says:

    Neil sez: “I think this is one huge argument for Health Savings Accounts”

    Sure, right. At a $5,000 a year HSA contribution, your five year cancer survival will only require 75 years to save up, assuming you don’t have a single medical expense over those 75 years.

  6. Neil H. says:

    artk: You are forgetting John Goodman’s proposal to create special accounts for chronic patients. There is no reason why the insurance company needs to control all the money.

    Think casualty insurance – similar to what you have on you home or automobile. A catastrophic event triggers a payment to the insured, who then makes his own buying decisions.

  7. artk says:

    The referenced article discusses Xeloda. Another alternative would be to be English and get it from their National Health Service for free. It’s an approved drug.

  8. Linda Gorman says:

    According to The Wall Street Journal, Medicare has a similar problem with IV antibiotics. Part A only pays for hospital administered IVs. If you have a condition that lets you use one of the new backpack setups, Medicare won’t pay for it unless you have Part B coverage. The backpack systems cost a lot less. They also mean that people don’t have to be hospitalized. Only have Part A? Tough.

    Private insurers will cover pumps because they save them money. Government spendings other people’s money so there is no urgency to change artificial divisions that cost hundreds of thousands a year.

  9. Neil H. says:

    According to the WHO, 25,000 British patient die prematurely each year because they do not get the cancer drugs that are available elsewhere in Europe and in the United States.

    So becoming English and expecting free care could be a lethal choice.