Many people are studying the rising prices of cancer drugs. A growing group of oncologists want to do something different: they want to give them a downward push.
Last week, a group of 118 oncologists signed an editorial published in the Mayo Clinic Proceedings in which they laid out seven specific actions that they argue would moderate drug prices.
The editorial cites a petition on Change.org, a social media platform routinely used to get hundreds of thousands signatures for campaigns, including ones to convince drug companies to provide developmental drugs to individual patients on compassionate basis, or to bring attention to medical practices including the use of power morcellation.
“A cancer patient-based grassroots movement that advocates against the high price of cancer drugs can accomplish a great deal,” the Mayo Clinic Proceedings editorial states. “Should this petition or any other similar grassroots efforts generate in aggregate an immense number of unique supporters (e.g., >1 million petition signees or a comparable mass action quantified in other terms), this quantified support can then be used by advocates, lobbyists, and others to advocate against the aforementioned harms generated by the high price of cancer drugs.”
The seven actions listed in the paper are:
(1) Creating a post-FDA drug approval review mechanism to propose a fair price for new treatments, based on the value to patients and health care.
(2) Allowing Medicare to negotiate drug prices.
(3) Allowing the Patient-Centered Outcomes Research Institute, created through the Affordable Care Act initiatives to evaluate the benefits of new treatments, and similar organizations to include drug prices in their assessments of the treatment value.
(4) Allowing importation of cancer drugs across borders for personal use (e.g., prices in Canada are about half of prices in the U.S.).
(5) Passing legislation to prevent drug companies from delaying access to generic drugs (pay-for-delay).
(6) Reforming the patent system to make it more difficult to prolong product exclusivity unnecessarily (patent “evergreening”).
(7) Encouraging organizations that represent cancer specialists and patients (e.g., American Society of Clinical Oncology, American Society of Hematology, American Association for Cancer Research, American Cancer Society, National Comprehensive Cancer Network) to consider the overall value of drugs and treatments in formulating treatment guidelines.
Focusing on Prices
“When you consider that cancer will affect one in three individuals over their lifetime, and [with] recent trends in insurance coverage [that] put a heavy financial burden on patients with out-of-pocket expenses, you quickly see that the situation is not sustainable,” said Ayalew Tefferi, a hematologist at Mayo Clinic and lead author of the paper. “It’s time for patients and their physicians to call for change.”
An interview with Tefferi and the Mayo Clinic is available here.
The editorial and the petition are direct, more focused outgrowth of a campaign launched by Hagop Kantarjian, chair of the Department of Leukemia at MD Anderson Cancer Center.
Kantarjian’s conversation with The Cancer Letter appears on page 1.
The Change.org petition has received over 20,000 supporters so far.
Many key players in oncology are focused on the price of cancer drugs. ASCO published the conceptual framework for assessment of value of cancer therapies (The Cancer Letter, June 26). Similarly, Peter Bach, a researcher at Memorial Sloan-Kettering Cancer Center, released his DrugAbacus tool for assessing the value of cancer drugs (The Cancer Letter, June 19).
These petitions have been known to succeed on occasion, prompting companies to make drugs available to individual patients, but drug pricing is infinitely more complex than turning over an unstudied agent to one person who wants it.
So far, the only case where a drug company has rolled back its price occurred three years ago, when top doctors at Memorial Sloan-Kettering Cancer Center said publicly that they would exclude a Sanofi drug from the center’s formulary because it was priced twice as high as an analogous drug (The Cancer Letter, Nov. 16, 2012; Nov. 8, 2012; Nov. 2, 2012).
The editorial is signed by:
• Ayalew Tefferi, Mayo Clinic, Rochester
• Vincent Rajkumar, Mayo Clinic, Rochester
• Morie Gertz, Mayo Clinic, Rochester
• Robert Kyle, Mayo Clinic, Rochester
• Hagop Kantarjian, MD Anderson Cancer Center
• James Allison, MD Anderson Cancer Center
• Robert Bast Jr., MD Anderson Cancer Center
• Jorge Cortes, MD Anderson Cancer Center
• Isaiah Fidler, MD Anderson Cancer Center
• Emil Freireich, MD Anderson Cancer Center
• Jordan Gutterman, MD Anderson Cancer Center
• Waun Ki Hong, MD Anderson Cancer Center
• Gabriel Hortobagyi, MD Anderson Cancer Center
• John Mendelsohn, MD Anderson Cancer Center
• Louise Strong, MD Anderson Cancer Center
• Naoto Ueno, MD Anderson Cancer Center
• Charles LeMaistre, MD Anderson Cancer Center
• Lawrence Baker, University of Michigan
• Theodore Lawrence, University of Michigan
• Jan Abkowitz, University of Washington
• Joachim Deeg, University of Washington
• Elihu Estey, University of Washington
• Gary Lyman, University of Washington
• John Adamson, University of California, San Diego School of Medicine
• Ranjana Hira Advani, Stanford University
• Steven Coutre, Stanford University
• Peter Greenberg, Stanford University
• Michael Link, Stanford University
• Saul Rosenberg, Stanford University
• Karen Antman, Boston University
• John Bennett, University of Rochester Medical Center
• Edward Benz Jr., Dana-Farber Cancer Institute and Harvard Medical School
• George Peter Canellos, Dana-Farber Cancer Institute and Harvard Medical School
• George Daley, Dana-Farber Cancer Institute and Harvard Medical School
• Daniel DeAngelo, Dana-Farber Cancer Institute and Harvard Medical School
• Charles Fuchs, Dana-Farber Cancer Institute and Harvard Medical School
• Robert Handin, Dana-Farber Cancer Institute and Harvard Medical School
• Philip Kantoff, Dana-Farber Cancer Institute and Harvard Medical School
• David Steensma, Dana-Farber Cancer Institute and Harvard Medical School
• Richard Stone, Dana-Farber Cancer Institute and Harvard Medical School
• Eric Winer, Dana-Farber Cancer Institute and Harvard Medical School
• Nancy Berliner, Brigham and Women’s Hospital
• Robert Handin, Brigham and Women’s Hospital
• Joseph Bertino, Rutgers Cancer Institute of New Jersey
• Ravi Bhatia, University of Alabama at Birmingham
• Smita Bhatia, University of Alabama at Birmingham
• Harry Erba, University of Alabama at Birmingham
• Deepa Bhojwani, Children’s Hospital Los Angeles
• Charles Blanke, Oregon Health & Science University
• Clara Bloomfield, The Ohio State University Comprehensive Cancer Center
• John Byrd, The Ohio State University Comprehensive Cancer Center
• Raphael Pollock, The Ohio State University Comprehensive Cancer Center
• Linda Bosserman, City of Hope
• Stephen Forman, City of Hope Medical Foundation
• Hal Broxmeyer, Indiana University
• Lawrence Einhorn, Indiana University
• Fernando Cabanillas, Auxilio Cancer Center, Hato Rey, Puerto Rico
• Bruce Chabner, Massachusetts General Hospital
• Gerardo Colon-Otero, Massachusetts General Hospital
• Asher Chanan-Khan, Mayo Clinic, Jacksonville, Fla.
• James Foran, Mayo Clinic, Jacksonville, Fla.
• Bruce Cheson, Georgetown Lombardi Comprehensive Cancer Center
• Bayard Clarkson, Memorial Sloan Kettering Cancer Center
• Sergio Giralt, MSKCC
• Clifford Hudis, MSKCC
• Ross Levine, MSKCC
• Martin Tallman, MSKCC
• Anas Younes, MSKCC
• Andrew Zelenetz, MSKCC
• Susan Cohn, University of Chicago
• Harvey Golomb, University of Chicago
• Samuel Hellman, University of Chicago
• Richard Larson, University of Chicago
• Wendy Stock, University of Chicago
• Massimo Cristofanilli, Sidney Kimmel Cancer Center at Thomas Jefferson University
• Walter Curran Jr., Winship Cancer Institute of Emory University
• Fadlo Khuri, Winship Cancer Institute of Emory University
• Sagar Lonial, Winship Cancer Institute of Emory University
• George Daley, Boston Children’s Hospital
• Joachim Deeg, Fred Hutchinson Cancer Research Center
• Gary Lyman, Fred Hutchinson Cancer Research Center
• Oliver Press, Fred Hutchinson Cancer Research Center
• Jerald Radich, Fred Hutchinson Cancer Research Center
• Brenda Sandmaier, Fred Hutchinson Cancer Research Center
• Rainer Storb, Fred Hutchinson Cancer Research Center
• Francisco Esteva, New York University Langone Medical Center
• James George, University of Oklahoma Health Sciences Center
• Paulo Marcelo Hoff, Universidade de Sao Paulo
• Ronald Hoffman, Icahn School of Medicine at Mount Sinai
• Mary Horowitz, Medical College of Wisconsin
• Jean Pierre Issa, Temple University
• Bruce Evan Johnson, Lowe Center for Thoracic Oncology
• Kenneth Kaushansky, Stony Brook University
• David Khayat, Pitié-Salpêtrière Hospital, Paris
• Thomas Kipps, University of California, San Diego Moores Cancer Center
• Scott Lippman, University of California, San Diego Moores Cancer Center
• Margaret Kripke, Cancer Prevention and Research Institute of Texas
• Maurie Markman, Cancer Treatment Centers of America, Eastern Regional Medical Center
• Neal Neropol, University Hospitals Case Medical Center and Case Western Reserve University
• Yoav Messinger, Children’s Hospitals and Clinics of Minnesota
• Therese Mulvey, Southcoast Centers for Cancer Care
• Susan O’Brien, University of California, Irvine
• Richard Van Etten, University of California, Irvine
• Roman Perez-Soler, Albert Einstein College of Medicine
• Josef Prchal, University of Utah
• Kanti Rai, North Shore-LIJ Cancer Institute
• Jacob Rowe, Northwestern University Feinberg School of Medicine
• Hope Rugo, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center
• Carolyn Runowicz, Florida International University Herbert Wertheim College of Medicine
• Alan Saven, Scripps Clinic Medical Group
• Richard Silver, Scripps Clinic Medical Group
• Andrew Schafer, Weill Cornell Medical College
• Charles Schiffer, Barbara Ann Karmanos Cancer Institute, Detroit
• Mikkael Sekeres, Cleveland Clinic
• Lillian Siu, Princess Margaret Cancer Centre, University Health Network, Toronto
• Marc Stewart, Seattle Cancer Care Alliance
• Michael Thompson, Aurora Research Institute, Aurora Health Care
• Julie Vose, University of Nebraska Medical Center
• Peter Wiernik, Cancer Research Foundation