Melanoma: From Impossible to Treat to Poster Child for Targeted Therapies | Page 8
Published Online: October 23, 2013
Produced by Nicole Beagin
Malin: I think clearly the cost of these new therapies is a challenge, just as the overall cost of healthcare is a major challenge for our country. There was a recent article in the American Journal of Family Practice that was looking at the rate of rise of healthcare premiums and out-of-pocket costs, and in just a few years basically the cost that both the employer and the individual pay for their health insurance, along with their out-of-pocket costs, will be equal to half of the median family income. So clearly it is not conceivable that costs can continue to go up. We can not spend really more than we already are of our incomes on our healthcare, so as we get new, innovative therapies that are more and more expensive, in order to pay for them, it means that the dollars have to come from somewhere else in the healthcare system. Now the good news is we think that 30% of what we spend on healthcare is waste, so if we can figure out how to stop doing the things that don’t help people, we can insure that we can continue to make sure to make new therapies that are highly innovative available to people, but figuring out where that waste is, and getting people to stop doing things that don’t provide value is challenging, and I think you know the comments made about the costs will come down, the costs will come down likely if we can exert pressure like formularies.
It is interesting, you look at the fact that there are 3 aromatase inhibitors that have gone generic, on 2 of them the price dropped to $20 a month and 1 of them is still at $300 a month, but most oncologists don’t even realize there is a difference in price, that either the patient is or isn’t paying at the pharmacy but their employer is paying a difference, and that is a big difference in the cost for a very active therapy that is equally effective. We have to, I think, as health plans and for pharmacists that are managing patients’ pharmacy benefits plans, we have to be mindful of the evidence and certainly we want to insure that people always get the most effective therapy, but in order to insure that competition really does have these drugs be available at a price that everyone has access to, we are going to have to use tools like formularies and pathways to highlight where things are equally effective if the cost is out of line and prefer those treatments that are lower cost so that we can insure that people have access to these therapies.
Fendrick: Thank you very much. I have to say that I’ll finish where you started on this idea of value, or Dr Weber started it, on the issue of clinical nuance, which is something that is critically important to what we do at The American Journal of Managed Care, which is identifying that services differ in the value that they create and the current benefit designs that patients see, they pay the same out of pocket for lifesaving drugs as they do for drugs that I wouldn’t give my dog, and we are focusing very much on the issue of waste. I think all 3 of you know about the Choosing Wisely initiative, which is now over 50 medical societies identifying services of low or no value, which is bringing a clinically driven umbrella to the trade-offs between high-value services and low-value services, and what we do at The American Journal of Managed Care and the Center for Value-Based Insurance Design is to exactly reiterate what Dr Malin said, to make those services on which the evidence is strong accessible to patients and profitable to providers, and hopefully turn the corner and no longer make it profitable or easily accessible to patients to do services for which the evidence is weak, or in some cases, where there is true evidence of harm.