Part 3: Conclusions
Innovative cancer drugs offer new hope for cancer patients, including opportunities for improved quality of life and long-term survival, even cure. However, oncology drug costs are increasing far more rapidly than costs of other components of cancer care. Virtually all new cancer drugs enter the market with a price tag higher than $100,000 per year, and increasing numbers of patients are being treated with these high-priced new drugs. Use of drug combinations may exacerbate the problem dramatically. Faced with staggering out-of-pocket costs for drugs and other components of cancer care, some patients suffer financial toxicity or forego needed treatment, which may shorten survival.
Urgent action is needed to address ongoing, rapid increases in cancer drug costs while continuing to stimulate innovation in drug development. This complex problem will not be solved quickly or easily, and it will not be solved by any organization or sector working alone. Proposed strategies and policies should be tested to ensure effectiveness in real-world settings and to minimize negative, unintended consequences; moreover, impact on the total cost of cancer care must be considered. Efforts to address drug costs should adhere to the guiding principles listed below.
Cancer drug prices should be aligned with value to patients. Prices of new cancer drugs entering the market are now uniformly high, regardless of novelty or clinical efficacy. High prices should be reserved for transformative, highly effective drugs. A foundational step toward this pricing approach is to develop and adopt a widely accepted framework for assessing the value of cancer drugs. Though value has many components, benefits experienced by patients must be central to any framework. Transparency and clear communication are essential to ensure that patients have all the information they need—including on potential benefits and side effects, as well as costs—to enable them to choose which treatment option best reflects their needs, values, and preferences.
All patients should have affordable access to appropriate cancer drugs. High-quality cancer care—including the most appropriate branded and/or generic drugs—should be accessible to all patients without the threat of financial toxicity. High-quality health insurance with prescription drug coverage is essential for limiting out-of-pocket costs. Very few uninsured or underinsured patients could afford to pay full price for cancer drugs, particularly the innovative new drugs entering the market. Improvements in health insurance coverage achieved over the past few years in the United States should be expanded, not reversed. Ability to pay should not be the predictor of who lives and who dies.
Investments in science are essential to drive future innovation. Biomedical research is the foundation of innovative drug development. Continued advances in cancer treatments depend on steadfast support for basic, translational, clinical, and population sciences research. Investments in regulatory science and infrastructure are essential to accelerate patients’ access to innovative drugs by ensuring that drugs are efficiently and effectively evaluated, both before and after market entry. Developers of innovative drugs also should be financially rewarded to incentivize and support future innovation. These steps will help ensure that future drugs have transformational, not incremental, impact.
Rising cancer drug costs are unprecedented and cannot be ignored—the consequences for patients, families, and society are too great. If current trends continue, spending on drugs will undermine ability to pay for other healthcare needs or invest in other critical priorities, like education and infrastructure. More than ever, affordable access to drugs will be the difference between life and death for cancer patients. The Panel urges all stakeholders—drug developers and manufacturers, policy makers, government, public and private payers, healthcare institutions and systems, providers, and patients—to work together to ensure that patients have access to innovative, high-value, and affordable cancer drugs. The ultimate goal is to ensure that patients receive high-quality cancer treatment and experience the best possible health outcomes without financial toxicity.