The cost of cancer care now averages over $100,000. That’s more than twice the cost of cancer treatment a decade ago. Still, pharmaceutical companies are prepared to test their monopoly pricing power further with new breakthrough drugs. Stat News reports that a new leukemia drug, just approved, will cost $475,000.
Some assert that the new drug from Novartis, CTL019, could be worth its high price, at $475,000. But, at that price, it’s likely that most people who need it will not be able to benefit from it. As Kaiser Health News reports, in the words of David Mitchell, founder of Patients for Affordable Drugs, “drugs don’t work if patients can’t afford them.”
CTL109 is a CAR T-cell therapy. This new drug class harvests the patient’s immune cells and then genetically alters them to kill the cancer. In CAR-T cell therapy tests, more than eight in 10 people with leukemia, for whom chemotherapy and bone-marrow transplants have not worked, have gone into remission.
The cost for CAR T-cell therapies is on top of the cost of hospitalization and traditional chemotherapy, which patients must receive in order to increase the chances of the CAR T-cell therapies working. And, as with many recently approved drugs, the side effects could be serious. One drug company stopped developing one of its CAR T-cell therapies after five patients died from complications associated with the therapies.
If Congress doesn’t intervene on the price of this drug (which it is unlikely to do), it could mean higher insurance premiums and health care costs for everyone. Medicare is required to cover all drugs on health plans’ formularies and is forbidden from negotiating prices. That said, the Centers for Medicare and Medicaid Services just issued a press release indicating that it is working with stakeholders on innovative pricing models for the drug, including a value-based pricing model, whatever that means.
Novartis reports that it is working with CMS to charge Medicare for the drug only if patients respond to the CAR T-cell treatment within a month. But, Vinay Prasad, an oncologist and health research at Oregon Health Sciences University, told Politico that one month is too soon to assess the drug’s value. Patients might relapse after a year or two.
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