Dr Iuliana Shapira on Managing High Costs of Immuno-Oncology Drugs in Value-Based Care

Iuliana Shapira, MD, chief medical officer, Regional Cancer Care Associates (RCCA), discusses how RCCA is managing the higher costs of immuno-oncology drugs in value-based care.

Iuliana Shapira, MD, chief medical officer, Regional Cancer Care Associates (RCCA), discusses how RCCA is managing the higher costs of immuno-oncology drugs in value-based care.


How is RCCA managing the higher cost of immune-oncology drugs in value-based care?

First of all, there is an old myth that you should not give up on a patient until you’ve given them immunotherapy. We have more and more knowledge in the literature that immunotherapies do not work in certain cancers, and that data is rapidly incorporated into our care pathways. There is a problem in giving immunotherapy to patients that have certain cancers with specific mutations because immunotherapy may actually worsen the patient’s survival and may actually make that cancer more aggressive, in addition to the fact that immunotherapy, just like any other therapy, has side effects. When we take the brakes off of our immune system, our immune system starts attacking normal organs. So, that is a limitation of immunotherapy to patients.

Certain patients should not get immunotherapy because they already have an immune-mediated disease. So, their immune system is already out of order. Giving them immunotherapy might just stimulate that pathology that already exists. That’s one way to mitigate costs associated with unnecessary immunotherapy. Following strict national guidelines of cancer care is very important.

The second very important development in controlling the cost of immunotherapy has just happened a few months back when Novartis agreed with one of the larger insurers in Germany to give the money back for immunotherapy that did not work in a patient. Novartis has a CAR [chimeric antigen receptor] T-cell therapy that has a cost of about $500,000 per patient, and Novartis agreed that if that patient dies, or his disease or her disease progresses within a certain time limit, they will give back the money to the insurance company. Obviously that type of arrangement, value-based arrangement, should be translated in the United States. We strongly believe that the patient should have a money-back guarantee when using medication. Just like we all as consumers have money-back guarantees when we buy a product that does not fulfill the promises.

So, in addressing the high costs of prescription medication immunotherapy and any other medications that are out of reach, we should not bankrupt the patient and we should not bankrupt the system with bad drugs. If the drugs do not fulfill their promise, the money should be reimbursed to the patient and the insurer. This can happen because we as oncologists follow national standardized guidelines. So, if the promised drug is the drug that we use in the condition and under circumstances and we’re approved to use the drug, if the drug doesn’t do the job, the drug company has to reimburse the money. That’s one way to reduce costs.

The second way is to provide price transparency. Patients have the right to know how much immunotherapy costs versus another immunotherapy. They have to know that upfront, not have a bill sent at the end of treatment. Price transparency ensures that the patients know the cost and they have options to choose among different medications that are recommended by their physicians. I think that these are 2 interventions—price transparency, choice, and money-back guarantee—that will ensure our healthcare doesn’t go bankrupt with treatments that do not fulfill their promise.