Breakthrough Through the Cost of Breakthrough Drugs

Medical science is bustling with new discoveries every year. New and promising cancer treatments are in the works, in the process of approval, and many are already approved by the FDA and on the market. But sadly, due to their high costs, insurance plans may restrict access to these breakthrough drugs. As a result, patient care may suffer. An analysis of managed care access was needed to discover if this was true and provide answers.

Analyzing Trends

In an article titled, Patient Access to Oral Breakthrough Cancer Drugs in the United States, reviewed and analyzed the trends in five states for access to these new orally delivered wonder drugs. Trends were analyzed by the name of the drug at both the state and national level.

The Results of The Analysis

In the five states selected, 94% of the insurance plans covered the drugs Ibrance, Zydelig, Ofev, Zykadia, and Imbruvaica at the Tier 5 level. While the remaining plans covered them at Tier 4 or 6. Co-insurances ranged from 25% to 35% of the retail cost of each drug, with a majority of the insurance plans requiring a co-insurance of 25%. The vast majority of the plans (97%) required pre-authorization before the drugs would be covered and imposed quantity limits. Twenty one pills for twenty-eight days, for example, could cost between $800 to over $14,000 dollars.

The Conclusions of The Study

Managed care access in the U.S. market for these wonderful new oral cancer treatments proved to be greatly restricted. This proved to be true regardless of the drug’s price or indication.

What Must Be Changed

In order to provide the best treatment, policies need to be changed or creative policies implemented to improve patient access to these drugs.

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