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Evidence-Based Oncology Patient-Centered Oncology Care 2016

Panel Presents Unique Cost-Sharing Viewpoints in Oncology Care

Christina Mattina
Panelists from diverse vantage points in the cancer care landscape discussed the effects of cost sharing on patients in a discussion at the 5th annual Patient-Centered Oncology Care® meeting.
DURING THE 5TH ANNUAL PATIENT-CENTERED ONCOLOGY CARE® MEETING, stakeholders with diverse experiences in the cancer care landscape discussed the effects of cost sharing during the panel, “Does Cost Sharing Influence Patient Adherence and Outcomes in Oncology?”

Moderator Joseph Alvarnas, MD, associate professor, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, kicked off the discussion by referencing a “poignant and powerful” speech made the night before in which Allison Morse, a cancer survivor, discussed her experiences negotiating drug prices at the pharmacy and having to choose between paying rent or for her cancer medications. To begin the panel discussion, he turned to another patient advocate, Samantha Watson, MBA, founder and CEO of the Samfund, who explained the impacts of cost sharing from the perspective of the patient.

Watson explained that “when the burden of cost sharing falls too heavily on the patient,” it forces them to make “impossible decisions” between their financial health and their physical health. In her experience, most patients confronted with this choice will “incur the cost no matter what” by using a credit card, but some will decide to skip treatment altogether.

From a payer perspective, William H. Shrank, MD, MSHS, chief medical officer of the University of Pittsburgh Medical Center Health Plan, said that the harm and suffering experienced by patients in these instances result from “a blunt formulary without really thoughtful consideration about the clinical nuance.”

Jonas A. de Souza, MD, MBA, assistant professor of medicine at the University of Chicago, concurred that benefits must be redesigned to alleviate the out-of-pocket cost burden on patients. He compared cancer care to an iceberg, with financial issues like cost sharing being at the tip. “This tip is what will sink the ship,” he warned, by bankrupting patients and actually worsening their chances of survival.

As president of the Patient Access Network (PAN) Foundation, Daniel J. Klein, MHS, has seen the consequences of this “broken system” first hand. His organization helps patients navigate their high out-of-pocket (OOP) costs and provides financial assistance that allows 90% of recipients to initiate or stay on their cancer treatments. Without this safety net, however, there are many cracks that patients can fall through, even in programs like Medicare, Klein said.

Shrank added that although patient assistance programs sponsored by pharmaceutical companies are far from ideal, “there are a lot of stopgaps to help patients meet their needs if they know how to access them.” Watson agreed, but expressed concern that patients often do not access the significant amount of resources that are available to them. She argued that the disconnect between patients and resources indicates a much larger problem— that the OOP costs affecting patients’ treatment decisions are not acknowledged by the current system.

Acknowledging that charitable assistance can be difficult for patients to navigate, Klein said that a bigger issue is actually the ineffectiveness of cost sharing. Patients with cancer are not more likely to become better healthcare consumers when they are asked to pay a copay or deductible, he said. Alvarnas suggested that cost sharing could be used to improve the system by directing patients toward preferred pathways and prioritizing efficient drugs. Shrank agreed that cost sharing at its core is meant to work as a barrier, but that an alternative approach to value could instead reward patients for adhering to their treatment regimens, so “all of those pieces can fit into a rich, value-based contracting design.”

The idea that cost sharing could be used as both a tool and a barrier was reinforced by de Souza, who suggested providing incentives to patients for preventive services or palliative care while also discouraging low-value care. He also discussed the possibility of implementing dynamic benefit design, such as different OOP costs for the same drug based on its benefit for the patient’s specific condition.

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