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TABLE OF CONTENTS
3 • Spending and Costs
Introduction
3
Chapter 1 Advances in Treatment
4
Chapter 2 Medicines in Development
17
Chapter 3 Value and Spending
24
INTRODUCTION
Researchers and clinicians are making remarkable progress
in the fight against cancer; death rates have declined overall
and for many patients, cancer has become a chronic
condition to be managed, instead of a death sentence.
However, the many different forms of cancer still cause
enormous suffering for patients and their families, and a
substantial economic burden in the United States. New
cancer medicines, along with screening and prevention
efforts, play a valuable role in improving patient outcomes.
To sustain continued progress in an environment of
increasing pressure to contain health care costs, it is
important to understand the role innovative treatments play
in the fight against cancer.
1
ADVANCES IN CANCER
TREATMENT
Cancer Medicines Are Benefiting Patients
In recent decades we have seen remarkable progress in the
fight against cancer. Research has advanced from viewing
cancer as a monolithic disease to understanding it better on a
molecular and genomic level.
With this greater understanding has come an increase in
treatment options that have helped to lengthen lives, improve
patients’ quality of life, and increase productivity. Patients
today have better treatment options than ever before.
1 • Advances in Treatment
Five-Year Survival is Increasing for Many Types of Cancer
Since 1975, the chances that a cancer patient will live 5 years or more have increased by 41% across cancers.1
5-Year Survival Rates Among the Most
Common Cancers, 1975-20111
100%
100%
92%
80%
1975
2012
75%
68%
60%
67%
50%
40%
83% of survival
gains in cancer are
attributable to new
treatments —
including medicines.2
20%
19%
12%
0%
Breast Cancer
Prostate Cancer
Colon/Rectum
Lung/Bronchus
Sources: 1) American Cancer Society, “Cancer facts & Figures 2016,” http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. 2) E. Sun, et al., “The
Determinants of Recent Gains in Cancer Survival: An Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database,” Journal of Clinical Oncology, May 2008 Suppl (Abstract
1 • Advances in Treatment
6616); http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf.
Since Peaking in the Early 1990s, Cancer Death Rates
Have Declined 23%1
Increases in cancer survival are estimated to translate to the avoidance of nearly 1.7 million cancer deaths.1
Cancer Death Rate (Number of Deaths Due
to Cancer per 100,000)
U.S. Death Rates from Cancer Decline Over Time2
- 23%
200
150
100
50
0
215
166.3
1991
2012
Sources: 1) American Cancer Society, “Cancer facts & Figures 2016,” http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. 2) National Cancer
Institute
and End Results database, “SEER Stat Fact Sheet: Cancer of Any Site,” http://seer.cancer.gov/statfacts/html/all.html. Accessed May 2016.
1 •Surveillance,
AdvancesEpidemiology,
in Treatment
The Number of Cancer Survivors is Steadily Rising
The continued increase in survival rates is in large part attributable to earlier detection and better treatments.1
U.S. Cancer Survivors Over Time1,2,3
19 million
13.7 million
9.8 million
3 million
1971
2001
2014
2024
(Projected)
Sources: 1) American Cancer Society, “Cancer Treatment and Survivorship Facts & Figures, 2014-2015,”
http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-042801.pdf. 2) Centers for Disease Control and Prevention, “Cancer Survivors-United States, 2007,”
10 March 2011, http://www.cdc.gov/cancer/survivorship/what_cdc_is_doing/research/survivors_article.htm. 3) R Siegel, et al., “Cancer Treatment and Survivorship Statistics, 2012.,” CA:
1 • Journal
Advances
in Treatment
A Cancer
for Clinicians.
doi: 10.3322/caac.21149.
Survival Rates for Childhood Cancers Have Increased
43% Over the Last Several Decades
Experts attribute gains in pediatric cancer survival to new and improved treatments, as well as high rates of
participation in clinical trials.
5-Year Survival Rates Among Childhood Cancer Patients
+ 43%
83%
58%
mid-1970s
Today
1 •American
Advances
inSociety,
Treatment
Source:
Cancer
“Cancer facts & Figures 2016,” http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf.
Ongoing Research and Use of a Medicine Over Time Reveals
Additional Benefits That May Not Have Been Recognized Initially
FDA approval and introduction
of a new therapy is a significant
milestone for patients but it is only
the beginning.
Additional value may be realized
over time through:1
 Earlier use
 Use in combination with other agents
 Use in specific sub-populations of
patients using diagnostics
 Use in other disease indications
Our knowledge of the full benefits of
a therapy emerges over time, through
continued research and real world
clinical practice.
“The relative value of a given cancer
treatment is likely to change over its
lifetime… the assessment of the value
of any treatment must be dynamic and
adapt to new medical information that may
better inform its use, mitigate its toxicity, or
modify its place in the treatment landscape.”
— American Society of Clinical Oncology2
Source: 1) Boston Healthcare Associates, “The Value of Innovation in Oncology: Recognizing Emerging Benefits Over Time,” Boston Healthcare Associates, Inc., May 2015. 2) ASCO.
9 ASCO
1 • Advances
in Treatment
Publishes
Conceptual Framework
to Assess the Value of New Cancer Treatment Options. June 22, 2015;
Ongoing Research Reveals Efficacy in Additional Targeted Patient
Group: Crizotinib for Non-Small Cell Lung Cancer (NSCLC)
Initially approved to treat patients with ALK+ mutated NSCLC, rapidly evolving science and ongoing research
revealed that crizotinib is effective in treating another rare, difficult-to-treat form of the disease as well.
2011
Accelerated approval
in ALK+ patients,
based on evidence of
tumor shrinkage
(surrogate endpoint)
2016
NEW indication
approved for patients
with a different
genetic subtype
(ROS-1+)
2013
Regular, confirmatory
approval granted
based on superior
progression-free
survival
“The expanded use of Xalkori will
provide a valuable treatment option
for patients with the rare and difficult
to treat ROS-1 gene mutation by
giving health care practitioners a
more personalized way of targeting
ROS-1 positive NSCLC.”
- Dr. Richard Pazdur, director of the Office
of Hematology and Oncology Products,
U.S. FDA Center for Drug Evaluation and Research
Sources: Timeline: National Cancer Institute, “FDA Approval for Crizotinib,” http://www.cancer.gov/about-cancer/treatment/drugs/fda-crizotinib (Accessed May 2016). Quote: U.S. Food
and Drug Administration, “FDA expands use of Xalkori to treat rare form of advanced non-small cell lung cancer,”
1 • Advances in Treatment
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm490329.htm.
Continuing Research Reveals Greater Benefit in Targeted Patient
Population: Gefitinib for Non-Small Cell Lung Cancer (NSCLC)
After approval, clinical studies in broader NSCLC patient population showed limited efficacy. However, ongoing
research revealed that patients with a specific mutation demonstrated significant survival gains.
2003
Accelerated approval
as second- or thirdline treatment based
on tumor shrinkage
2015
Approved for first-line
use in patients with
specific mutations (EGFR
exon 19 deletions or
exon 21 L858R
substitutions)
2005
Indication limited to those
currently benefiting from
treatment due to ongoing
clinical studies that fail to
show significant survival
“Gefitinib is a textbook example of
how much oncology has changed
over the past decade. The trial to
follow up and get full approval of
gefitinib wasn't designed with smart
selection of patients based on
mutations.”
-Dr. Lecia Sequist, Medical Oncologist,
Massachusetts General Hospital
Sources: Timeline: National Cancer Institute, “FDA Approval for Gefitinib.” http://www.cancer.gov/about-cancer/treatment/drugs/fda-gefitinib (Accessed May 2016).; U.S. Food and Drug
Administration, “Gefitinib (Iressa),” http://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm454692.htm (accessed May 2016).Quote: “Gefitinib Approved for EGFR-Mutated
1 • Advances in Treatment
NSCLC.” Cancer Discovery September 2015 5:896..
Targeted Therapies Drive Survival Gains in Chronic Leukemias
Since the approval of the first tyrosine kinase inhibitor (TKI) for chronic myeloid leukemia (CML), survival rates
have improved dramatically and patients are living close to normal life spans.1
•
Imatinib—the first TKI—was approved
in 2001 to treat CML. The
transformative impact of this class of
medicines had not been completely
realized.
•
After initial approval, continued
research revealed that imatinib had a
greater impact when initiated earlier
in the progression of the disease.
•
Further research also revealed that
imatinib was effective in combating
other types of cancer
•
5-Year Survival Rates for CML Patients Nearly
Triple After Introduction of Imatinib2
89%
31%
Additional TKIs have since been
approved that target mutated forms of
CML in patients who have become
resistant or intolerant to imatinib.
Prior to Introduction of
Imatinib
After Introduction of Imatinib
Source: 1) PhRMA, “A Decade of Innovation in Rare Diseases: 2005‐2015,” http://www.phrma.org/sites/default/files/pdf/PhRMA-Decade-of-Innovation-Rare-Diseases.pdf, 2015; 2)
American Cancer Society, “Cancer Facts and Figures 2016,” 2016; BJ Druker, et al., “Five‐year follow‐up of patients receiving imatinib for chronic myeloid leukemia,” N Engl J Med. 2006;
1 • Advances in Treatment
355(23):2408‐17.
Cervical Cancer: Reduced Incidence of Cancer-Causing
HPV Infections
Among teenage girls, widespread use of the quadrivalent human papilloma virus (HPV) vaccine has driven down
infection rates by nearly two-thirds.
Source: Markowitz, L, et al. “Prevalence of HPV After Introduction of the Vaccination Program in the United States.” Pediatrics. March 2016.
1 • Advances in Treatment
http://pediatrics.aappublications.org/content/early/2016/02/19/peds.2015-1968.
Immunotherapy is Revolutionizing the Treatment of
Many Advanced Cancers: Metastatic Melanoma
Immuno-oncology medicines are enabling the body to unleash the brakes on the immune system, overcoming
signals that cancer cells have exploited. Early advances in advanced melanoma are particularly promising.
Note: Data from KEYNOTE-001 pembrolizumab clinical study
“No recent cancer advance has been more
transformative than immunotherapy. These new
therapies are not only transforming patient lives,
they are also opening intriguing avenues for further
research.”
- Dr. Julie M. Vose, President of the American Society of Clinical
Oncology3
Sources: 1) ASCO, “PD-1 Inhibitor Pembrolizumab Provides Long-Term Survival Benefit for Patients With Advanced Melanoma,” May 18, 2016, https://www.asco.org/about-asco/press-center/news-releases/pd1-inhibitor-pembrolizumab-provides-long-term-survival; 2) The ASCO Post. “ASCO Names Advance of the Year, Highlights Major Top Research Trends.” February 10 2016.
http://www.ascopost.com/issues/february-10-2016/asco-names-advance-of-the-year-highlights-major-top-research-trends/; 3)Southall, A. “Former President Jimmy Carter Says He is Free of Cancer.”
1 • Advances in Treatment
http://www.nytimes.com/2015/12/07/us/jimmy-carter-cancer.html. Dec. 6, 2015.
Cancer Treatment Advances Result in Substantial
Gains to Society
23 MILLION
=
$1.9 TRILLION =
Years of life saved due to cancer treatment
advances, 1988-2000
Value of improved cancer treatment to society
based on improved productivity, extended life
and other factors, 1988-2000
1 •DNAdvances
Source:
Lakdawala ,in
et Treatment
al. , “An economic evaluation of the war on cancer,” Journal of Health Economics. May 2010. 29(3):333-346.
Continued Innovation in Cancer Treatment Could Echo
HIV/AIDS Successes
As HIV/AIDS treatments improved, spending became sustainable. It is estimated that, as a result of highly active
antiretroviral treatments (HAART), we were able to avoid over 862,000 premature deaths, gain over 27 million
life-years, and gain $615 billion in economic value over the cost of treatment in the United States alone.
“Remember HIV?.... thanks to a wave of
new discoveries that came both from
academic centers and the pharmaceutical
industry, the HIV crisis was transformed
into a stable condition which is managed
very differently by society where good
drugs are available. They are controlling
the disease, and society has been saving
an enormous amount of money as a
result of these innovative drugs by
providing better care out of hospitals.”
— Hervé Hoppenot, President,
Incyte Pharmaceuticals
Sources: Truven Health Analytics http://truvenhealth.com/Portals/0/Assets/Life-Sciences/White-Papers/pharma-innovation-hiv-aids-treatment.pdf; M Kean, T Lessor (Eds.), “Sustaining
5 • Against
Improving
Care
Sustained
Innovation
Progress
CancerCancer
in an Era of
CostThrough
Containment
Discussion Paper,”
June 2012, available at: www.TurningTheTideAgainstCancer.org.
16
2
MEDICINES IN
DEVELOPMENT
Discovery and Development of Cancer Medicines
The R&D process remains challenging and expensive but
advances in basic science have opened new doors for
biopharmaceutical researchers.
More than 1,200 new cancer medicines are in clinical
development in the U.S. These medicines represent a wide
range of novel approaches. Patients today have more reason
to hope than ever before.
2 • Medicines in Development
17
Promise in the Pipeline: More than 800 Medicines in
Development for Various Cancers
Number of Medicines in Development in the United States,
September 2015, Selected Cancer Types*
Bladder Cancer
Brain Cancer
Breast Cancer
Colorectal Cancer
Head/Neck Cancer
Hematological Malignancies
Kidney Cancer
Leukemia
Liver Cancer
Lung Cancer
Lymphoma
Multiple Myeloma
Ovarian Cancer
Pancreatic Cancer
Prostate Cancer
Phase I
Phase II
Phase III
Application Submitted
“These are exciting
times… the pace of
discovery and
application of new
knowledge to patient
care is rapidly
accelerating.”
— Dr. Jose Baselga, Physician-inChief, Memorial Sloan Kettering
Cancer Center, New York, NY,
President of the American
Association for Cancer Research
Sarcoma
Skin Cancer
Stomach Cancer
Other Cancers
*Some medicines are being explored in more than one therapeutic category.
18
Sources: PhRMA, “Cancer Medicines in Development,” September 2015, http://phrma.org/sites/default/files/pdf/oncology-report-2015.pdf; American Association for Cancer Research.
2 • Medicines in Development
“Jose Baselga, MD, PhD” http://cancerprogressreport.org/2015/Pages/baselga.aspx .
Biopharmaceutical Companies are Driving Advances in
Targeted Cancer Therapy
Personalized medicines are transforming the treatment of many forms of cancer and the pipeline has never been
more promising.
12-50%
Of new drugs in the
pipeline are reportedly
personalized medicines
(across all diseases)
19
2 •1)Medicines
Sources:
Tufts Center in
for Development
the Study of Drug Development (CSDD). Personalized medicine gains traction but still faces multiple challenges. Tufts CSDD Impact Rep. 2015.
Cancer Researchers Build on Knowledge Gained from
Setbacks in Order to Inform Future Advances
Developing a new cancer medicine is a complex process, fraught with setbacks, but these so called “failures”
are not wasted efforts. Researchers learn from them to inform future study and direct research efforts.
“The scientific process is thoughtful, deliberate, and sometimes slow, but each
advance, while helping patients, now also points toward new research questions
and unexplored opportunities.”
— Clifford A. Hudis, MD, FACP Chief, Breast Medicine Service, Memorial Sloan Kettering Cancer Center;
Professor, Weill Cornell Medical College
*Setbacks and advances from 1998 to 2014
20
2 •PhRMA,
Medicines
in Development
Source:
“Researching
Cancer Medicines: Setbacks and Stepping Stones,” http://www.phrma.org/sites/default/files/pdf/2014-cancer-setbacks-report.pdf, 2014.
New Approaches to Treating Cancers Represent the
Majority of Medicines in the Oncology Pipeline
Researchers are using novel approaches to attack cancer at the molecular level. An average of 80% of drugs in the
oncology pipeline may be first-in-class medicines.
Percentage of Projects in Development that Are Potentially
Novel Approaches in Selected Cancer Areas, 2011
Bladder cancer
75%
Blood cancers
77%
Breast cancer
76%
Colorectal cancer
81%
Lung cancer
75%
Melanoma
91%
Prostate cancer
75%
Cancer, general
80%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Source: G. Long and J. Works. “Innovation in the Biopharmaceutical Pipeline: A Multidimensional View.” Boston, MA: Analysis Group, January 2013. Available at
2 • Medicines in Development
www.analysisgroup.com/uploadedFiles/Publishing/Articles/2012_Innovation_in_the_Biopharmaceutical_Pipeline.pdf
(accessed May 2016).
Major Scientific Advances in Cancer Treatment Pipeline
Give Patients Hope
The cancer pipeline is ripe with innovative therapeutic options. Emerging combinations of medicines hold
particular promise for controlling and killing cancer cells.
Chimeric Antigen
Receptor (CAR) T-Cell
Adoptive Cell Therapy
involves the modification
of individuals’ immuneboosting T-cells to target
and kill blood cancer cells.
Oncolytic viral therapies zero
in on cancer cells, replicate,
and cause them to rupture.
Cancer Metabolism-Targeting
Drugs disrupt cancer cell
metabolism and can impede
cancer cell growth.
Immunotherapies help
target and kill cancer cells by
“releasing the breaks” on
the immune system.
CRISPR Gene Editing allows
researchers to manipulate
cancer cell function.
“We are in the midst of a sea
change in how we are treating
cancer. We’re really seeing the fruits
of many years of research into what
drives cancer and how it interacts
with the immune system to defeat it
and survive.”
- Dr. Louis Weiner, director of the Georgetown
Lombardi Comprehensive Cancer Center
Sources: World Medical Innovation Forum: Cancer. “Disruptive Dozen 2016.” http://worldmedicalinnovation.org/wp-content/uploads/2016/04/Partners-FORUM-2016-BROCHURE-D12Cancer-160422_0942-FREV1-WEB-X3-SM-SPREADS.pdf; McGinley, L. “The list of cancers that can be treated by immunotherapy keeps growing.” The Washington Post.
2 • Medicines in Development
https://www.washingtonpost.com/news/to-your-health/wp/2016/04/19/breakthrough-cancer-therapy-shows-growing-promise/
CAR-T Therapy Driving Breakthroughs for Cancer Patients
2 • Medicines in Development
3
3 • Spending and Costs
VALUE AND SPENDING
Understanding the Value of Cancer Medicines
New cancer medicines bring great value to patients and the
health care system. It is important to view cancer spending in
the context of health care spending overall. Likewise, cancer
medicines are a crucial part of oncology treatment but
represent just a small portion of cancer costs.
24
Spending on Cancer Medicines Represents About 1% of
Overall Health Care Spending
Cancer Medicines as a Portion of
NHE Projected Total U.S. Health Care Spending, Billions, 2015
$39.1 Billion
Cancer Drug Spending
$3.2 Trillion*
Total Health
Care Spending
$124 billion
All Remaining Health
Care Spending
* 2015 CMS Total National Health Expenditures Number is a projection
Source: IMS Institute for Healthcare Informatics, “Medicines Use and Spending in the U.S.: A Review of 2015 and Outlook to 2020”; CMS National Health Expenditures Projections. July
• Spending and Costs
2015.3https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html
Average Price Growth of Cancer Drugs in Medicare
Part B Less than Medical Inflation
The trend of volume-weighted Average Sales Price (ASP) for cancer drugs administered through Medicare Part B
has been growing more slowly than overall medical inflation
Weighted ASP vs. CPI-M*
$10.00
500
450
$8.00
400
$6.00
300
250
$4.00
200
150
$2.00
100
50
$-
-
Oncology Drugs
Medical Care
Note: Total retail sales including brand medicines and generics.
* 2014 Weighted ASP numbers are projections.
3 •The
Spending
and Costs
Source:
Moran Company.
Trends in Weighted Average Sales Prices for Prescription Drugs in Medicare Part B, 2006-2013. April 2014.
CPI-M
Weighted ASP
350
Part B Cancer Medicines Are Serving Unmet Medical
Needs
According to the Government Accountability Office, medicines under Medicare Part B have an important role in
advancing patient care.
25 new Part B cancer
•
FDA’s expedited review programs are
designed to accelerate the development
and review of new drugs that meet unmet
medical needs.
•
New Part B cancer therapies are serving
previously unmet medical needs for patients
with colorectal cancer, renal cell carcinoma,
breast cancer, prostate cancer, multiple
myeloma, leukemia, and lymphoma.
•
The modest increase in Part B spending
primarily reflects uptake of these important
advances, not changes in price.
medicines approved
2006-2013
88% of these
products were
approved with
expedited review.
Source:
3 •Government
SpendingAccountability
and Costs Office. “Expenditures for New Drugs Concentrated among a Few Drugs, and Most Were Costly for Beneficiaries.” October 2015.
Patients in Only 6 Countries Had Access to at Least Half
of the 49 New Oncology Medicines Launched 2010-2014
2015 Global Availability of Oncology Medicines Launched 2010-2014
8
11 12
18 21 21
25 26 27
29 29 30
36 36
49
41 38
37
31 28 28
24 23 22
20 20 19
Available
13 13
40 42 43 43 43
44
9
7
6
6
6
5
48
1
Not Available
Notes: Includes innovative medicines, often referred to as New Active Substances or New Chemical Entities, first launched globally between 2010 and
2014. Availability is based on sales in audited markets, regardless of reimbursement rates. Supportive care medicines are not included.
Source: IMS Institute for HealthCare Informatics. “Global Oncology Trend Report. A Review of 2015 and Outlook to 2020”.
Even When Commercially Available, Not All Cancer Medicines Are
Reimbursed Under Public Insurance Programs
Percent of Approved Cancer Medicines
Reimbursement Status of Cancer Medicines Approved in 2014 and 2015
100%
43%
90%
62%
65%
67%
71%
71%
71%
76%
38%
35%
33%
29%
29%
29%
24%
95%
80%
70%
60%
50%
100%
40%
30%
57%
20%
10%
5%
0%
U.S
France
United
Kingdom
Australia
Scotland
Reimbursed
Sweden
Germany
Italy
Canada
Spain
Not Reimbursed
Note: The categorization of not-reimbursed does not mean that there is no patient access to these medicines , and there may be non-standard means
for obtaining access to new medicines through special funds and submission of applications for approval outside of standard guidelines.
Source: IMS Institute for HealthCare Informatics. “Global Oncology Trend Report. A Review of 2015 and Outlook to 2020”.
The Role of Personalized Medicines Has Grown in the
Last Decade
Personalized medicines provide effective and efficient care by targeting the right medicine to the
right patient.
Oncology Treatment Modalities in Top Pharmaceutical Markets,
2003-2013
2013
2003
11%
11%
24%
48%
26%
15%
46%
Targeted
46%
Medicines
10%
20%
Source: IMS Institute for Healthcare Informatics, “Innovation in Cancer Care and Implications for Health Systems: Global Oncology Trend Report,” May 2014.
Over Time, Targeted Oncology Drugs Generate
Additional Treatment Options for New Indications
Through ongoing research, our understanding of the genetic and molecular mutations driving cancer cell
growth is uncovering commonalities among cancer types and the medicines used to treat them.
Targeted Oncology Medicine FDA Approval Type by Year
10
9
14
5
3
9
4
6
2
2
1
3
2
4
1
3
7
2
2
11
6
4
3
2
1
1
0
2001 2002 2003 2004 2005 2006 2007 2008
2009 2010 2011 2012 2013 2014 2015
First Approvals
Subsequent Approvals
Source: IMS Institute for Healthcare Informatics, “Medicines Use and Spending in the U.S.: A Review of 2015 and Outlook to 2020”; CMS National Health Expenditures Projections. July
2015. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html.
Health Plans Have Powerful Tools to Reduce Spending on
Cancer Medicines
Current and Anticipated Payer Measures to Manage Oncology Costs
Utilizing one or more value frameworks* in the evaluation
of new cancer therapies to determine physician
reimbursement, price-for-performance (pay for value),
preferential utilization contracts, etc.
Implementing steps to increase savings from non-oncology
categories
Using clinical pathways to determine which treatment
regimens will be approved for patients
31%
25%
Q1 2016
27%
25%
35%
39%
59%
Contracting for preferred agents among first-line therapies
52%
Percentage of Payers
*Value Frameworks: NCCN Evidence Blocks, ASCO Value Framework, etc.
Source: Zitter Health Insights , Managed Care Oncology Index, 2016.
Q1 2017
Insurance Covers a Lower Share of Prescription
Drug Costs than of Other Medical Services
On average, patients pay out of pocket nearly 20% of their total prescription drug spending, compared to 5%
of spending for hospital care.
Average Share of Health Costs Patients Pay Out of Pocket, All Ages
40%
30%
20%
19%
Average, All Health Care
10%
5%
0%
Hospital
Prescription Drugs*
*Includes brand and generic
Sources: PhRMA analysis of Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2009. Available at www.meps.ahrq.gov/mepsweb/ (accessed March 2014).
Prescription drug spending includes brand and generic ingredients, pharmacy, and distribution costs. Estimates are not restricted to individuals who have private coverage that includes
prescription coverage, which can be expected to account for less than 2%.; P.J. Cunningham. “Despite the Recession's Effects on Incomes and Jobs, the Share of People with High Medical
Costs was Mostly Unchanged.” Health Affairs 2012; 31(11): 2563–2570.
Multiple Factors Contribute to the Financial Burden
Faced by Cancer Patients
Physician services, transportation expenses, and inability to work, among other things, also drive the cost
burden on cancer patients, often more so than prescription drugs.
Top Patient Financial Concerns
Among cancer patients who contacted the
National Patient Advocate Foundation for
financial help with in 2015.
Co-pay for facility/doctor visits
10.4%
Transportation
8.8%
Co-pay for drugs
7.4%
Rent/mortgage
6.2%
Utilities
4.7%
Source: J. O’Donnell. “Patient groups funded by drugmakers are largely mum on high drug prices,” USA Today. http://www.usatoday.com/story/news/nation/2016/01/21/patient-groupsdrug-makers-high-drug-prices/79001722/.