WASHINGTON (AP) - Chemotherapy is now available in a pill, but if you have Medicare, you may not be able to afford it.
That’s what happened to Rita Moore when she took her prescription for a medication to treat kidney cancer to her local drugstore. She was stunned when the pharmacist told her a month’s supply of the pills would cost $2,400, more than she makes.
Medicare prescription plans that cover seniors like Moore are allowed to charge steep copayments for the latest cancer drugs, which can cost tens of thousands of dollars a year. About 1 in 6 beneficiaries are not filling their prescriptions, according to recent research that suggests a worrisome trend.
Officials at Medicare say they’re not sure what happens to those patients _ whether they get less expensive older drugs that sometimes work as well, or they just give up. Traditionally, chemotherapy has been administered intravenously at a clinic or doctor’s office. Pills are a relatively new option that may represent the future of cancer care.
Moore, 65, was operated on in February for an advanced form of kidney cancer. As she faced a life-and-death struggle, both her cancer and kidney specialists agreed a drug called Sutent offered the best chance. It’s a capsule you can take at home.
But Moore was unprepared for what happened when she went to fill her prescription.
“I cried,” said Moore, who lives in the small central California town of Corcoran. “What can you do when the only thing out there that can maybe give you some quality of life is unaffordable? I was devastated. I didn’t know what to do.”
Private insurance companies that deliver the Medicare prescription benefit say the problem is that drug makers charge too much for the medications, some of which were developed from taxpayer-funded research. The pharmaceutical industry faults insurers, saying copayments on drugs are higher than cost-sharing for other medical services, such as hospital care.
Some experts blame the design of the Medicare prescription benefit itself, because it allows insurers to put expensive drugs on a so-called “specialty tier” with copayments equivalent to 25 percent or more of the cost of the medication.
Drugs for multiple sclerosis, rheumatoid arthritis and hepatitis C also wind up on specialty tiers, along with the new anti-cancer pills. Medicare supplemental insurance _ Medigap _ doesn’t cover those copayments.
“This is a benefit design issue,” said Dan Mendelson, president of Avalere Health, a research firm that collaborated in a recent medical journal study on the consequences of high copayments for the new cancer drugs.
Cost-sharing should only be used to deter wasteful treatment, he explained. “It is hard to make the argument that someone who has been prescribed an oral cancer medication doesn’t need the drug,” added Mendelson.
The study last month in the Journal of Oncology Practice found that nearly 16 percent of Medicare beneficiaries did not fill an initial prescription for pills to treat cancer, a significantly higher proportion than the 9 percent of people with private insurance who did not follow through.
Forty-six percent of Medicare beneficiaries faced copayments of more than $500, as compared to only 11 percent of patients with private insurance. Among people of all ages, 1 in 4 who faced a copayment over $500 did not fill their prescriptions. Cancer is more prevalent among older people.
“Obviously, we’re leaving a lot of folks off the bus, standing at the curb, if they can’t afford the medications,” said Dr. Lowell Schnipper, who chairs the American Society of Clinical Oncology’s task force on the cost of cancer care. It advises doctors to discuss costs with patients up front, to avoid surprises.