Cancer Patients Need Affordable Access to Therapies Recommended by Their Doctors

While innovative therapies are improving care, barriers to access may prevent patients from benefiting.

Although innovations in therapy are making advances in the care of people living with multiple myeloma, insurance companies are keeping many patients from affording those medications.

Novel, innovative cancer medicines are increasingly being placed in “specialty” tiers in health insurance plans, requiring patients to pay a high percentage of the costs. Medicines used to treat myeloma are among the most likely to be placed in specialty tiers of prescription coverage plans, according to a report published by the Medicare Access for Patient Rx Coalition.

“If you’re asked to pay a 30 to 50 percent coinsurance for a therapy, it can mean thousands of dollars out of your pockets,” said Meghan Buzby, Senior Director of Advocacy at the International Myeloma Foundation (IMF). “If you take away options because of high costs, it’s a matter of life or death for myeloma patients.”

According to a survey published in Cancer Nursing, myeloma patients reported spending an average of 36 percent of their income on their treatment during the first year of treatment.

The Financial Burden of Multiple Myeloma

At their worst, financial burdens can prevent cancer patients from taking their medications. A study published in the Journal of Clinical Oncology found that chronic myeloid leukemia patients with high copays were 70 percent more likely to stop taking their medication and 42 percent more likely to skip or incorrectly take doses.

“For patients to realize the full benefits of these advances in myeloma therapies, affordable access is essential,” said Frank Lichtenberg, PhD, professor of economics at Columbia University.

According to Lichtenberg’s recent analysis of 38 countries published in Social Science & Medicine, countries that provided better access to new treatment options for myeloma between 2002 and 2012 had greater declines in myeloma mortality rates.

To ensure myeloma patients have access to the medicines that they need, the IMF is leading two coalitions, the Patient Equal Access Coalition (PEAC) and the State Patients Equal Access Coalition (SPEAC), to drive legislative changes at the federal and state levels, respectively.

So far, SPEAC has helped 34 states pass laws providing protection for patients from high copays or coinsurance. On the federal level, PEAC has been building momentum, recruiting 92 bipartisan cosponsors for the proposed Cancer Drug Coverage Parity Act during the last Congressional session and preparing to reintroduce the legislation in the new session.

Even if the parity act passes, patients on Medicare will remain unprotected. “Unfortunately, a majority of our patients are Medicare patients,” Buzby said. “We know that it is an issue for them, and we have already discussed regulatory solutions with the Center for Medicare and Medicaid Services.”

Footnotes 

1. Goodwin Julia A., Coleman Elizabeth Ann A., Sullivan Ellen, et al. Personal financial effects of multiple myeloma and its treatment. Cancer Nursing. 2013;36:301-308. http://www.ncbi.nlm.nih.gov/pubmed/23047800