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3 • Spending and Costs
TABLE OF CONTENTS
Introduction
Chapter 1 Advances in Treatment
Chapter 2 Medicines in Development
Chapter 3 Value and Spending
3
4
17
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 Treatment
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 CancerSince 1975, the chances that a cancer patient will live 5 years or more have increased by 41% across cancers.1
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 6616); http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf.
5-Year Survival Rates Among the Most Common Cancers, 1975-20111
75%68%
50%
12%
92%
100%
67%
19%
0%
20%
40%
60%
80%
100%
Breast Cancer Prostate Cancer Colon/Rectum Lung/Bronchus
1975
2012
83% of survival
gains in cancer are attributable to new treatments —including medicines.2
1 • Advances in Treatment
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
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 Surveillance, Epidemiology, and End Results database, “SEER Stat Fact Sheet: Cancer of Any Site,” http://seer.cancer.gov/statfacts/html/all.html. Accessed May 2016.
U.S. Death Rates from Cancer Decline Over Time2
215 166.30
50
100
150
200
1991 2012
Can
cer
De
ath
Rat
e (
Nu
mb
er
of
De
ath
s D
ue
to
Can
cer
pe
r 1
00
,00
0)
- 23%
1 • Advances in Treatment
The Number of Cancer Survivors is Steadily RisingThe continued increase in survival rates is in large part attributable to earlier detection and better treatments.1
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: A Cancer Journal for Clinicians. doi: 10.3322/caac.21149.
3 million
9.8 million
13.7 million
19 million
1971 2001 2014 2024(Projected)
U.S. Cancer Survivors Over Time1,2,3
1 • Advances in Treatment
Survival Rates for Childhood Cancers Have Increased 43% Over the Last Several DecadesExperts attribute gains in pediatric cancer survival to new and improved treatments, as well as high rates of participation in clinical trials.
Source: American Cancer Society, “Cancer facts & Figures 2016,” http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf.
58%
83%
mid-1970s Today
+ 43%
5-Year Survival Rates Among Childhood Cancer Patients
1 • Advances in Treatment
Ongoing Research and Use of a Medicine Over Time Reveals Additional Benefits That May Not Have Been Recognized Initially
Earlier use
Use in combination with other agents
Use in specific sub-populations of patients using diagnostics
Use in other disease indications
9Source: 1) Boston Healthcare Associates, “The Value of Innovation in Oncology: Recognizing Emerging Benefits Over Time,” Boston Healthcare Associates, Inc., May 2015. 2) ASCO. ASCO Publishes Conceptual Framework to Assess the Value of New Cancer Treatment Options. June 22, 2015;
“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
Additional value may be realized over time through:1
FDA approval and introduction of a new therapy is a significant milestone for patients but it is only the beginning.
Our knowledge of the full benefits of a therapy emerges over time, through continued research and real world clinical practice.
1 • Advances in Treatment
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.
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,” http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm490329.htm.
2011Accelerated approval
in ALK+ patients, based on evidence of
tumor shrinkage (surrogate endpoint)
2013Regular, confirmatory
approval granted based on superior progression-free
survival
2016NEW indication
approved for patients with a different genetic subtype
(ROS-1+)
“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
1 • Advances in Treatment
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.
2003Accelerated approval as second- or third-
line treatment based on tumor shrinkage
2005Indication limited to those currently benefiting from treatment due to ongoing clinical studies that fail to show significant survival
2015Approved for first-line
use in patients with specific mutations (EGFR
exon 19 deletions or exon 21 L858R substitutions)
“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 NSCLC.” Cancer Discovery September 2015 5:896..
1 • Advances in Treatment
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
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; 355(23):2408‐17.
• 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
• Additional TKIs have since been approved that target mutated forms of CML in patients who have become resistant or intolerant to imatinib.
31%
89%
Prior to Introduction ofImatinib
After Introduction of Imatinib
5-Year Survival Rates for CML Patients Nearly Triple After Introduction of Imatinib2
1 • Advances in Treatment
Cervical Cancer: Reduced Incidence of Cancer-Causing HPV InfectionsAmong 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. http://pediatrics.aappublications.org/content/early/2016/02/19/peds.2015-1968.
1 • Advances in Treatment
Immunotherapy is Revolutionizing the Treatment of Many Advanced Cancers: Metastatic MelanomaImmuno-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.
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/pd-1-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.” http://www.nytimes.com/2015/12/07/us/jimmy-carter-cancer.html. Dec. 6, 2015.
“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
Note: Data from KEYNOTE-001 pembrolizumab clinical study
1 • Advances in Treatment
Cancer Treatment Advances Result in Substantial Gains to Society
Source: DN Lakdawala , et al. , “An economic evaluation of the war on cancer,” Journal of Health Economics. May 2010. 29(3):333-346.
23 MILLION
=
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
$1.9 TRILLION
=
5 • Improving Cancer Care Through Sustained Innovation
Continued Innovation in Cancer Treatment Could Echo HIV/AIDS Successes
16
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.
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 Progress Against Cancer in an Era of Cost Containment Discussion Paper,” June 2012, available at: www.TurningTheTideAgainstCancer.org.
“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
2 • Medicines in Development
2 MEDICINES IN DEVELOPMENTDiscovery 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.
17
2 • Medicines in Development
Promise in the Pipeline: More than 800 Medicines in Development for Various Cancers
18Sources: PhRMA, “Cancer Medicines in Development,” September 2015, http://phrma.org/sites/default/files/pdf/oncology-report-2015.pdf; American Association for Cancer Research. “Jose Baselga, MD, PhD” http://cancerprogressreport.org/2015/Pages/baselga.aspx .
*Some medicines are being explored in more than one therapeutic category.
“These are exciting times… the pace of discovery and application of new knowledge to patient care is rapidly accelerating.”
— Dr. Jose Baselga, Physician-in-Chief, Memorial Sloan Kettering Cancer Center, New York, NY, President of the American Association for Cancer Research
Number of Medicines in Development in the United States, September 2015, Selected Cancer Types*
Other Cancers
Stomach Cancer
Skin Cancer
Sarcoma
Prostate Cancer
Pancreatic Cancer
Ovarian Cancer
Multiple Myeloma
Lymphoma
Lung Cancer
Liver Cancer
Leukemia
Kidney Cancer
Hematological Malignancies
Head/Neck Cancer
Colorectal Cancer
Breast Cancer
Brain Cancer
Bladder Cancer
Phase I
Phase II
Phase III
Application Submitted
2 • Medicines in Development
Biopharmaceutical Companies are Driving Advances in Targeted Cancer Therapy
19Sources: 1) Tufts Center for the Study of Drug Development (CSDD). Personalized medicine gains traction but still faces multiple challenges. Tufts CSDD Impact Rep. 2015.
12-50%Of new drugs in the
pipeline are reportedly personalized medicines
(across all diseases)
Personalized medicines are transforming the treatment of many forms of cancer and the pipeline has never been more promising.
2 • Medicines in Development
Cancer Researchers Build on Knowledge Gained from Setbacks in Order to Inform Future AdvancesDeveloping 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.
20Source: PhRMA, “Researching Cancer Medicines: Setbacks and Stepping Stones,” http://www.phrma.org/sites/default/files/pdf/2014-cancer-setbacks-report.pdf, 2014.
“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
2 • Medicines in Development
New Approaches to Treating Cancers Represent the Majority of Medicines in the Oncology PipelineResearchers 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
80%
75%
91%
75%
81%
76%
77%
75%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Cancer, general
Prostate cancer
Melanoma
Lung cancer
Colorectal cancer
Breast cancer
Blood cancers
Bladder cancer
Source: G. Long and J. Works. “Innovation in the Biopharmaceutical Pipeline: A Multidimensional View.” Boston, MA: Analysis Group, January 2013. Available at www.analysisgroup.com/uploadedFiles/Publishing/Articles/2012_Innovation_in_the_Biopharmaceutical_Pipeline.pdf (accessed May 2016).
2 • Medicines in Development
Major Scientific Advances in Cancer Treatment Pipeline Give Patients HopeThe cancer pipeline is ripe with innovative therapeutic options. Emerging combinations of medicines hold particular promise for controlling and killing cancer cells.
Sources: World Medical Innovation Forum: Cancer. “Disruptive Dozen 2016.” http://worldmedicalinnovation.org/wp-content/uploads/2016/04/Partners-FORUM-2016-BROCHURE-D12-Cancer-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. https://www.washingtonpost.com/news/to-your-health/wp/2016/04/19/breakthrough-cancer-therapy-shows-growing-promise/
“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
Chimeric Antigen
Receptor (CAR) T-Cell
Adoptive Cell Therapy
involves the modification
of individuals’ immune-
boosting T-cells to target
and kill blood cancer cells.
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.
Oncolytic viral therapies zero
in on cancer cells, replicate,
and cause them to rupture.
CRISPR Gene Editing allows
researchers to manipulate
cancer cell function.
2 • Medicines in Development
CAR-T Therapy Driving Breakthroughs for Cancer Patients
3 • Spending and Costs
33 VALUE AND SPENDING
24
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.
3 • Spending and Costs
Spending on Cancer Medicines Represents About 1% of Overall Health Care Spending
Total Health Care Spending
$124 billion
Cancer Medicines as a Portion of NHE Projected Total U.S. Health Care Spending, Billions, 2015
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
$39.1 Billion
$3.2 Trillion*
Cancer Drug Spending
All Remaining HealthCare Spending
* 2015 CMS Total National Health Expenditures Number is a projection
3 • Spending and Costs
Average Price Growth of Cancer Drugs in Medicare Part B Less than Medical InflationThe 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
Source: The Moran Company. Trends in Weighted Average Sales Prices for Prescription Drugs in Medicare Part B, 2006-2013. April 2014.
Note: Total retail sales including brand medicines and generics.
-
50
100
150
200
250
300
350
400
450
500
$-
$2.00
$4.00
$6.00
$8.00
$10.00
CP
I-M
Wei
ghte
d A
SP
Weighted ASP vs. CPI-M*
Oncology Drugs Medical Care
* 2014 Weighted ASP numbers are projections.
3 • Spending and Costs
Part B Cancer Medicines Are Serving Unmet Medical NeedsAccording to the Government Accountability Office, medicines under Medicare Part B have an important role in advancing patient care.
Source: Government Accountability Office. “Expenditures for New Drugs Concentrated among a Few Drugs, and Most Were Costly for Beneficiaries.” October 2015.
25 new Part B cancer medicines approved
2006-2013
88% of these products were approved with
expedited review.
• 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.
Patients in Only 6 Countries Had Access to at Least Half of the 49 New Oncology Medicines Launched 2010-2014
49
41 38 3731 28 28
24 23 22 20 20 1913 13
9 7 6 6 6 5 1
8 11 1218 21 21
25 26 27 29 29 3036 36
40 42 43 43 43 4448
Available Not Available
2015 Global Availability of Oncology Medicines Launched 2010-2014
Source: IMS Institute for HealthCare Informatics. “Global Oncology Trend Report. A Review of 2015 and Outlook to 2020”.
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.
Even When Commercially Available, Not All Cancer Medicines Are Reimbursed Under Public Insurance Programs
100%
57%
38% 35% 33% 29% 29% 29% 24%
5%
43% 62% 65% 67% 71% 71% 71% 76% 95%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
U.S France UnitedKingdom
Australia Scotland Sweden Germany Italy Canada Spain
Perc
ent
of
Ap
pro
ved
Can
cer
Med
icin
es
Reimbursed Not Reimbursed
Source: IMS Institute for HealthCare Informatics. “Global Oncology Trend Report. A Review of 2015 and Outlook to 2020”.
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.
Reimbursement Status of Cancer Medicines Approved in 2014 and 2015
The Role of Personalized Medicines Has Grown in the Last Decade
Source: IMS Institute for Healthcare Informatics, “Innovation in Cancer Care and Implications for Health Systems: Global Oncology Trend Report,” May 2014.
11%
46%
Oncology Treatment Modalities in Top Pharmaceutical Markets, 2003-2013
Personalized medicines provide effective and efficient care by targeting the right medicine to the right patient.
11%
26%
15%
48%
2003
46%
20%
10%
24%
2013
Targeted Medicines
Targeted Oncology Medicine FDA Approval Type by Year
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.
Over Time, Targeted Oncology Drugs Generate Additional Treatment Options for New IndicationsThrough 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.
2 1 2
3
1
43
0
4
1
7
9
6
11
14
2 1
4
2
2
26
5 3
3
9
10
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
First Approvals Subsequent Approvals
Health Plans Have Powerful Tools to Reduce Spending on Cancer Medicines
Source: Zitter Health Insights , Managed Care Oncology Index, 2016.
Current and Anticipated Payer Measures to Manage Oncology Costs
Percentage of Payers
52%
39%
25%
25%
59%
35%
27%
31%
Contracting for preferred agents among first-line therapies
Using clinical pathways to determine which treatmentregimens will be approved for patients
Implementing steps to increase savings from non-oncologycategories
Utilizing one or more value frameworks* in the evaluationof new cancer therapies to determine physician
reimbursement, price-for-performance (pay for value),preferential utilization contracts, etc.
Q1 2017
Q1 2016
*Value Frameworks: NCCN Evidence Blocks, ASCO Value Framework, etc.
Insurance Covers a Lower Share of PrescriptionDrug Costs than of Other Medical ServicesOn average, patients pay out of pocket nearly 20% of their total prescription drug spending, compared to 5% of spending for hospital care.
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.
5%
19%
0%
10%
20%
30%
40%
Hospital Prescription Drugs**Includes brand and generic
Average Share of Health Costs Patients Pay Out of Pocket, All Ages
Average, All Health Care
Multiple Factors Contribute to the Financial Burden Faced by Cancer PatientsPhysician services, transportation expenses, and inability to work, among other things, also drive the cost burden on cancer patients, often more so than prescription drugs.
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-groups-drug-makers-high-drug-prices/79001722/.
4.7%
6.2%
7.4%
8.8%
10.4%
Co-pay for facility/doctor visits
Transportation
Co-pay for drugs
Rent/mortgage
Utilities
Top Patient Financial Concerns
Among cancer patients who contacted the National Patient Advocate Foundation for financial help with in 2015.
