The Emperor of All Maladies: Cancer Advances Meaningless When Patients Can’t Access Them

Insurers are making patients pay more for the innovative therapies featured in the new documentary “Cancer: The Emperor of All Maladies.”

In the past, a cancer diagnosis meant a death sentence to patients, but today, cancer patients have new hope as innovative therapies are being developed and approved. That’s the message of “Cancer: The Emperor of All Maladies,” a three-part six-hour documentary from executive producer Ken Burns, which airs on PBS March 30 to April 1, 2015.

But if health insurers continue to make cancer patients pay more for these therapies, those treatments might not be affordable options. Today, 48 percent of cancer patients say they paid more for health care over the past year, and treatment copays have been one of the primary drivers of those rising costs, according to a recent survey conducted by the Cancer Support Community.

“Some cancer patients are facing a significant economic burden because their insurance simply isn’t working for them,” Joel Beetsch, vice president of Global Patient Advocacy at Celgene, said. “The insurance landscape has fallen behind the pace of science. We all need to do our part to grant access to innovative therapies so the patient is always at the center of our actions.”

More than 30 percent of cancer patients reported being financially affected by their cancer care costs in a 2010 survey of over 2,100 cancer patients.

Those financial hardships negatively affected how patients rated their physical and mental states as well as overall satisfaction in social activities and relationships. In fact, financial hardship was the single strongest predictor of quality of life in cancer patients, according to an analysis of the survey results.

Specialty tiers, step therapy and other utilization management policies used by insurers that focus primarily on cost-savings can be detrimental to patients.

“We as a health care ecosystem continue to focus on the needs of cancer patients, and restricting access is not serving the best interests of our patients,” Beetsch said.

Instead of focusing on what is best for those they insure by providing affordable access to the new targeted therapies highlighted in the documentary, some insurers are raising costs for patients instead.

Health insurance plans sold through the Affordable Care Act marketplace are requiring patients to pay more for some medicines used to treat cancer. The proportion of Silver plans—the most popular plans purchased—that place all molecular targeted inhibitors, a type of innovative targeted cancer therapy, in specialty tiers jumped from 34 percent in 2014 to 47 percent in 2015. And since drugs on specialty tiers can force cancer patients to pay as much as half the cost, this increase can have devastating effects on more and more patients.

Insurers- increasingly place cancer therapies in specialty tiers.

“Specialty tiers, step therapy and other utilization management policies used by insurers that focus primarily on cost-savings can be detrimental to patients,” Beetsch said. “These policies must follow clinical guidelines approved by the medical community to ensure a focus on the patient’s health.”

Since cancer is not one disease but hundreds of different diseases, the one-size-fits-all approach to treatment promoted by some insurance plans will not be effective.

“Individuals must be treated in ways that are tailored to their individual disease,” Dr. Andrew L. Kung, chief pediatric oncology at the NewYork-Presbyterian/Columbia University Medical Center, said at a press briefing on the “Cancer: The Emperor of All Maladies” documentary held at Columbia University last week.

Restricting or delaying access to the right therapies increases the risk that the patient’s disease will worsen. Some states are taking action to increase access to medicines that can improve patient health and actually reduce health care spending, and hopefully the documentary will help raise awareness of these efforts and the innovative cancer research from leading oncologists.

“My hope is that everyone who watches this documentary will understand that we know more about cancer than ever before, innovation is driving the science forward, and access to that innovation will improve the lives of the patients we are all working to serve,” Beetsch said.