[Ip-health] USA Today: Skyrocketing drug prices leave cures out of reach for some patients

Jamie Love james.love at keionline.org
Mon Jun 15 09:02:05 PDT 2015


* Even patients with insurance can have trouble affording their medication,
Saltz said. Many insurance plans require patients to pay 20% of their
prescription drug costs. Some cancer patients have begun rationing their
pills to reduce costs, taking them every two days instead of daily, said
Ronan Kelly, an assistant professor of oncology at the Johns Hopkins Sidney
Kimmel Comprehensive Cancer Center in Baltimore. "If we don't get some
sanity in these drug prices, more people will die from cancer because no
one will be able to afford them," said Saltz, who addressed high drug
prices at a meeting of the American Society of Clinical Oncology.

* For many people, care for cancer and other serious diseases is "a doorway
to bankruptcy or poverty," said Timothy Turnham, executive director of the
Melanoma Research Foundation. "It's a tremendous economic burden." But
patients aren't the only ones paying. Taxpayers underwrite the cost of
prescription drugs provided by Medicare, Medicaid and other public
insurance programs.

* Medicaid programs across the USA are sharply restricting access to
Sovaldi, offering it only to the sickest patients, Myers said. Treating
hepatitis C, which is caused by a virus that can spread when injection drug
users share needles, actually helps prevent new cases, Myers said. That's
because curing the illness leaves fewer infectious people to spread it. "If
the drug had been priced more rationally, my expectation is that states
would try to treat everyone they could a hold of," Myers said. "Imagine if
Jonas Salk, when he invented the polio vaccine, had priced it like Gilead.
We'd still have polio."

* The landmark drug Gleevec, which transformed chronic myeloid leukemia
from a death sentence into a chronic disease, cost $31,488 when it was
approved in 2001, according to its manufacturer, Novartis. Its cost has
since tripled — to more than $110,000 — even though it now competes with
two similar drugs.


http://www.usatoday.com/story/news/2015/06/14/rising-drug-prices/71077100/

Skyrocketing drug prices leave cures out of reach for some patients

 Liz Szabo, USA TODAY 8:04 a.m. EDT June 15, 2015

Doctors and researchers are excited about new therapies derived from the
study of the human genome that hold the promise of curing multiple forms of
cancer using the patients’ own DNA to undo cancer cells. Mary Lee, USA TODAY

Sophisticated drugs are opening the door, scientists say, to an era of
"precision medicine."

They're also ushering in an age of astronomical prices.

New cancer drugs are routinely priced at more than $100,000 a year — nearly
twice the average household income.

Experimental cholesterol drugs — widely predicted to be approved this
summer — could cost $10,000 a year

A drug for a subset of people of cystic fibrosis, a lung disease that kills
most patients by their early 40s, commands more than $300,000 a year.

Even with insurance, patients might pay thousands of dollars a month out of
pocket.

For many people, care for cancer and other serious diseases is "a doorway
to bankruptcy or poverty," said Timothy Turnham, executive director of the
Melanoma Research Foundation. "It's a tremendous economic burden."

But patients aren't the only ones paying.

Taxpayers underwrite the cost of prescription drugs provided by Medicare,
Medicaid and other public insurance programs.

Spending on prescription drugs last year reached a record-breaking $374
billion, up 13% from 2013, with the largest percentage increase in more
than a decade, said Clare Krusing,spokeswoman for America's Health
Insurance Plans. Almost half of that increase came from drugs launched in
the past two years.

Some of the most expensive medications are "breakthrough" drugs, which are
fast tracked by the Food and Drug Administration because of their potential
to fill an unmet need, she said. Over the next decade, just 10 of these
breakthrough drugs will cost the government nearly $50 billion.

People with private insurance could find themselves paying more
out-of-pocket for health care if insurers raise premiums to cover their
costs, Krusing said.

"We're spending money we cannot afford," said Leonard Saltz, chief of
gastrointestinal oncology at New York's Memorial Sloan Kettering Cancer
Center.

Yet Saltz said he can't deny that some new drugs are game changers.

"I want these drugs and drugs like them available for my patients," Saltz
said.

The cystic fibrosis drug, Kalydeco, has changed 33-year-old Emily
Schaller's life. Before Kalydeco, Schaller was hospitalized for lung
infections two to three times a year. Since beginning the drug five years
ago, through a clinical trial, she's been hospitalized twice. Schaller, who
lives in Detroit, receives Kalydeco through Michigan's state-run health
insurance program.

Emily Schaller, 33, has benefitted from a new drug, Kalydeco, that treats
her cystic fibrosis. (Photo: Ian Pettigrew)

"It's a miracle drug," Schaller said. "I'm now planning a retirement fund,
which is something I never thought would need."

Yet miracles remain out of reach for many.

Even patients with insurance can have trouble affording their medication,
Saltz said. Many insurance plans require patients to pay 20% of their
prescription drug costs.

Some cancer patients have begun rationing their pills to reduce costs,
taking them every two days instead of daily, said Ronan Kelly, an assistant
professor of oncology at the Johns Hopkins Sidney Kimmel Comprehensive
Cancer Center in Baltimore.

"If we don't get some sanity in these drug prices, more people will die
from cancer because no one will be able to afford them," said Saltz, who
addressed high drug prices at a meeting of the American Society of Clinical
Oncology.

Rationing care

Each new drug approval seems to set a new floor for prices, as doctors,
patients and insurance providers get used to paying more, said David
Howard, an associate professor in the department of health policy and
management at Emory University in Atlanta.

So even drugs outside the domain of precision medicine are getting pricier.

Prices for insulin have skyrocketed in recent years, said Jeff Myers,
president and chief executive officer of Medicaid Health Plans of America,
which represents Medicaid managed care plans.

Drugs for multiple sclerosis, which cost $8,000 to $11,000 a year in the
1990s, now sell for about $60,000 a year, according to an April study in
Neurology.

But perhaps no single drug has caused as much sticker shock as Sovaldi,
approved in 2013 to treat chronic hepatitis C infections and cures 90% of
patients in 12 weeks.

But some people with hepatitis C will never have a chance to try it. At
$1,000 a pill, its price far exceeds that of many cancer therapies.

Unlike drugs for rare cancers, which might be used by a few thousand people
a year, Gilead Sciences' Sovaldi treats a condition that affects 3 million
people, Krusing said. The size of that patient population could make
Sovaldi a budget breaker, especially for state budgets, because many people
infected with hepatitis C are on Medicaid or in prison.

Medicaid programs across the USA are sharply restricting access to Sovaldi,
offering it only to the sickest patients, Myers said.

Treating hepatitis C, which is caused by a virus that can spread when
injection drug users share needles, actually helps prevent new cases, Myers
said. That's because curing the illness leaves fewer infectious people to
spread it.

"If the drug had been priced more rationally, my expectation is that states
would try to treat everyone they could a hold of," Myers said. "Imagine if
Jonas Salk, when he invented the polio vaccine, had priced it like Gilead.
We'd still have polio."

A spokeswoman for Gilead said Sovaldi's price reflects its value to
patients. Sovaldi cuts treatment time in half compared to older therapies,
Gilead spokeswoman Cara Miller said. Sovaldi also could end up saving
money, by reducing the need for liver transplants.

Like many drug companies, Gilead offers a program to help low-income
patients afford medications. Eligible patients can receive Sovaldi for as
little as $5 a month from Gilead's drug assistance program, Miller said.

A spokesman for the pharmaceutical industry said drug makers need to charge
enough to recoup their investment costs.

Research from Tufts University estimates that bringing a new drug to market
can take 10 years and $2.6 billion, said Robert Zirkelbach, a spokesman for
the Pharmaceutical Research and Manufacturers of America. Some health
policy analysts have questioned Tufts' estimate.

But Zirklebach said that charging more for successful drugs helps to offset
the losses from the many drugs that fail. And the pharmaceutical industry's
investments benefit patients, he said.

Drugs in development have "never been more promising," Zirkelbach said.
"That's particularly true in cancer. New medicines coming out have the
ability to completely transform cancer and provide hope where there has
never been hope before."

"What the market will bear"

Yet the high cost of new medications has nothing to do with their
effectiveness, said Vinay Prasad, chief fellow in oncology at the National
Cancer Institute.

In a study of all drugs approved from 2009 to 2013, Prasad found no
difference in cost between medications that improve survival the most and
those with no effect on survival. There was also no difference in the price
of the most innovative drugs — ones that worked in a totally new way —
compared with similar drugs that came later.

"Our ultimate consensus was that there is no rational basis for drug
prices," said Prasad, whose study was published in JAMA Oncology in April.
"It's not based on how novel they are or how well they work. It's based on
what the market will bear."

Competition hasn't helped to control prices, Saltz said.

By the time that brand-name drugs are available as low-cost generics,
"we're treating people with 17-year-old technology," Saltz said.

Some cancer drugs will never become available as generics, Turnham said.
That's because they're "biologics," drugs grown in living cells. Lower cost
versions of these drugs, called biosimilars, are projected to save patients
only about 15%, Turnham said.

Attendees tour the exhibit hall at the 2006 meeting of the American Society
of Clinical Oncology, where doctors gather to learn about the newest cancer
research. (Photo: Todd Buchanan)

And some prices continue to rise, in spite of competition from comparable
drugs.

The landmark drug Gleevec, which transformed chronic myeloid leukemia from
a death sentence into a chronic disease, cost $31,488 when it was approved
in 2001, according to its manufacturer, Novartis. Its cost has since
tripled — to more than $110,000 — even though it now competes with two
similar drugs.

Julie Masow, a spokeswoman for Novartis, said Gleevec is priced lower than
its competitors. Gleevec "is a life-changing medicine," she said. "Before
its availability many patients with chronic myeloid leukemia lived only
months to a few years. Today, nine out of ten patients have a near normal
lifespan."

Drug price increases show no sign of slowing.

The cost of new cancer drugs has been increasing by 10% a year, according
to a working paper published in the Journal of Economic Perspective.
Authors noted that drug companies tend to price new drugs just slightly
more than comparable drugs, leading prices to creep up every year.

Leonard Saltz, chief of gastrointestinal oncology at

Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan
Kettering Cancer Center in New York City, says cancer drugs today cost too
much. (Photo: Memorial Sloan Kettering Cancer Center)

Saltz and his colleagues at Memorial Sloan Kettering have taken a stand on
rising drug prices. The hospital's colorectal cancer specialists have
refused to use two drugs that cost more than their competitors.

In 2012, the hospital decided to stop stocking one of these drugs because
it cost more than twice the price of a drug that worked just as well. Saltz
and two of his colleagues then wrote about their decision in a newspaper
editorial.

Within three weeks, Saltz said, the company offered doctors and hospitals a
50% discount.


-- 
James Love.  Knowledge Ecology International
http://www.keionline.org/donate.html
KEI DC tel: +1.202.332.2670, US Mobile: +1.202.361.3040, Geneva Mobile:
+41.76.413.6584, twitter.com/jamie_love



More information about the Ip-health mailing list