Drug Costs and Medicare
Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work
JUNE 05, 2017
Not everyone with cancer has Medicare, but all of us are affected by Medicare rules. Since 1.7 million new cancer cases were diagnosed in the US in 2016 (!) and since the median age of those new patients was 65, it is clear that many people are going through Medicare-covered cancer treatment. The issue at hand is that Medicare does not automatically cover all new cancer drugs, especially not all new expensive cancer drugs. And other insurance carriers frequently take their cues from Medicare.
This is a wonky but extremely important editorial from the Journal of Clinical Oncology:
Cancer, Financial Burden, and Medicare Beneficiaries
Cathy J. Bradley
In the absence of altering price negotiation and mandatory coverage
policies, the Centers for Medicare and Medicaid Services proposed reforms
to counteract high prescription drug prices.
These reforms include incentivizing best clinical care (meaning choosing
lower-cost, clinically equivalent or better treatment options),
indication-based pricing, reference pricing, and risk sharing on the basis
A common feature of these approaches is that they shift the pressure to
physicians to reduce costs by making value-based prescribing decisions.
This may be impractical, given that the research and clinical practice
community operates without adequate or readily accessible evidence to
make these decisions, despite many attempts at distilling oncology cost
and benefit information in an efficient manner that is understandable
to both physicians and their patients.
Without evidence, physicians may not be aware of low-value prescribing
practices and are unable to appropriately counsel patients on how to
make a value-based decision.
Read more (this is an excerpt): http://ascopubs.org/doi/full/10.1200/JCO.2017.73.1877