By Richard M. Ingram
“You’ve got cancer.”
That’s one of the scariest sentences in the English language. But it’s less frightening than it used to be. Cancer death rates plummeted 29 percent between 1991 and 2017, according to the American Cancer Society. Survival rates have soared. Almost 99 percent of prostate cancer patients are still alive five years after diagnosis — up from 68 percent in the 1970s.
We can thank cutting-edge drugs for these gains. My fellow oncologists now prescribe breakthrough medicines rather than relying on old-school chemotherapies that kill healthy cells alongside tumorous ones.
Unfortunately, the government is about to make our jobs harder — and cut off access to cancer drugs for millions. The Centers for Medicare and Medicaid Services recently finalized a “most-favored-nation” rule, which was set to take effect on January 1.
The rule’s goal is to lower drug prices for Medicare patients. But the rule is sure to backfire, with tragic consequences.
The most-favored-nation rule imposes a cap on how much Medicare will pay for 50 drugs, including many cancer treatments. The limit is pegged to the amount government health systems in other developed countries pay for those drugs.
CMS hopes this tactic will force drug makers to lower prices. That’s a risky gamble. The rule notes that “some manufacturers will adhere to their current pricing instead of lowering sales prices.” The rule goes on to say “this behavior may persist,” and “would result in unmet demand.”
Patients who need specific cancer medications won’t get them. CMS assumes by 2023, 19 percent of Medicare recipients who would otherwise have received top-of-the-line therapies will not have access to them.
The rule will also jeopardize patients’ access to treatment by shuttering local oncology clinics. There are more than 2,100 community cancer centers around the United States, treating 65 percent of the nation’s cancer patients. These centers provide top-notch doctors, nurses, pharmacists, social workers, and financial counselors. Undergoing cancer treatment is an exhausting endeavor. These professionals make a life-or-death difference.
At my clinic, Shenandoah Oncology, we figuratively — and often literally — wrap our arms around patients. Our licensed clinical social workers provide emotional support to patients and families. Our pharmacists and nurse navigators guide patients through the ups and downs of treatment regimens. And our financial counselors sign patients up for assistance programs.
Drugs shrink tumors, but a full-spectrum support network enables patients to truly beat cancer.
Currently, clinics like mine buy drugs up front, administer medications, and then bill Medicare. The program reimburses us for the cost of the drugs plus a small fee to cover services provided by essential workers.
When the rule kicks in, the dollar amount of reimbursements to clinics will drop. Clinics will have to decide if they can afford to offer certain drugs. Worse, they’ll have to lay off staff and cut services, if not close altogether.
Many clinics will go out of business, leaving patients with no good options. Especially in rural areas, patients might have to drive hours to find a safety-net hospital. Those hospitals rarely provide the same resources and support.
If not reversed, the most-favored-nation rule will lead to lower quality life and earlier death for thousands. We have made enormous progress in combating cancer. Let’s not set it back.
Dr. Richard M. Ingram is a practicing medical oncologist and president of Shenandoah Oncology, in Winchester, Virginia. He is also president of the Virginia Association of Hematology Oncology, and volunteer on the board of directors of the Community Oncology Alliance. This piece originally ran in the Virginian-Pilot.