Treatments Can Be Expensive

Medical treatments for cancer can be expensive despite health insurance.

Cancer chemotherapy choices have always been made by the physicians who are treating you. Physicians traditionally have analyzed the risks to your health vs the benefits to be achieved by a particular drug treatment. Risks are evaluated by what the chemotherapy might adversely do to you. Reactions such as nausea, vomiting, loss of some nerve functions, skin rashes, cold intolerance, risks of infection or bleeding, and heart damage are all possible depending upon the drugs chosen. Benefits are evaluated by asking how many people might be cured or achieve better quality of life for a period of time on these drugs. If cure is possible, the risks people choose to take are much greater.

Recently, however, the non-medical risks of drug therapies have increased. Now there are risks of large insurance co-pays, or even non-coverage, of some therapies, such as the newer oral anti-cancer drugs. Each commercial insurance company (such as Blue Cross, Anthem or United Health Care) can determine the availability of these newer drugs to you by their own medical review process, and then determine their charges. But changes in this process are coming. As of early 2013, eighteen states and the District of Columbia have passed laws forcing health insurance companies to cover oral anti-cancer medications “under terms no less favorable” than those drugs that are administered intravenously. 

How much money can be involved? A physician blogging on January 28, 2013, about this issue reported that his patient’s co-pay for an oral medicine, abiraterone, was $ 2300 per month. How could that be? Today, oral anticancer medicines are reimbursed as a pharmacy benefit instead of as a medical benefit. That is an accounting change, not a medical one. If the drugs were categorized as a medical benefit, the patient's copays with each prescription would have different limits and there would also be a limit, a cap, on the patient's annual overall expense. Then, expenses, though high, would amount to a fraction of the costs mentioned above. The insurance companies have shifted their costs to you.

Co-pays are only one way that medical care through insurers has become more costly. Insurance premiums are also higher. Many patients who need certain drugs but can't afford them have few options. Not taking the drugs, spending less on food, or using retirement savings are some possibilities. None of these options is at all desirable.  Most patients might think about talking to their doctors about the costs, but, in the end, these conversations usually don't take place.

Patients with cancer or any other chronic, serious illness are very vulnerable. The vulnerability exists in part because cancer increases anxiety, and few patients want to question their physician’s decisions in a world as complicated as medicine. But these potentially large costs would certainly make me pause to ask just what the benefit is.  It should also make your physician ask the same question until the changes in laws of early 2013 that were seen in some states are widespread. Such laws will allow patients access to cancer treatments that they might otherwise deny themselves because of the costs.

Someone we love will get cancer. For those who cannot save for that rainy day, the options are to go through their savings and declare bankruptcy to get care through Medicaid. At this time, a leading cause of bankruptcy in America is medical care. For those who can save, the current insurance options will affect when they might retire and how they will be able to enjoy the rest of their lives. Those are consequences if nothing changes in the way that medical costs are covered.

People know that cancer care, and care for other serious illnesses, is expensive. For many people, most of that care is paid for through third parties (insurers), but the percentage of costs that the patient pays is rising and is painful.  The new Affordable Care Act that is replacing the old Medicare rules and regulations is intended to pay for care to those who need it.  Everyone should rally behind efforts to drive down the out-of-pocket costs of these drugs to patients.