It is becoming a more common occurrence these days. Doctors taking a strong and very public stand against what they perceive to be out-of-control pricing for cancer drugs. A few months ago, it was the famed Memorial Sloan-Kettering Cancer Center refusing to use for its patients a new drug called Zaltrap for treating advanced colorectal cancer. Now, it is a global gathering of prominent leukemia specialists loudly decrying the close to six-figure annual price tag for certain leukemia drugs. The question these doctors are raising in this escalating battle within the medical community is what price is a fair price to charge for a product when the buyer’s health and well-being, perhaps their very life, may depend on it.
The leukemia doctors — numbering 120 strong from 15 countries on five continents — took their stand last week in a hard-hitting article they released in Blood, the medical journal published by the American Society of Hematology. Leading the charge was Dr. Hagop Kantarjian, chairman of the leukemia department at the prestigious MD Anderson Cancer Center in Houston. In their paper, Dr. Kantarjian and his colleagues complained about what they perceive to be the “spiraling prices of cancer drugs.” They noted that 11 of the 12 cancer drugs the FDA approved last year were priced above $100,000, and that cancer drug prices have almost doubled in the past decade from roughly $5,000 to $10,000 per month.
As a specific example within their own field, these specialists pointed to imatinib, a drug used to treat chronic myelogenous leukemia (CML). It was originally priced at $30,000 per year when first introduced in 2001. It now sells for more than $90,000 per year, with annual 2012 sales of roughly $4.7 billion. From the perspective of the protesting doctors, there is no justification for this tripling of price. All research costs for the drug were accounted for in the original price. New indications for the drug were developed and the FDA approved broadening its market base. And the prevalence of the patient population taking the drug has dramatically increased. The unfortunate result is that because of its prohibitive pricing, only about a quarter of the patients with this particular form of leukemia are taking this important drug.
Which highlights the key point these experts are trying to make — that something needs to be done to rein in the cost of cancer drugs:
As physicians, we follow the Hippocratic Oath of “Primum non nocere,” first (or above all) do no harm. We believe the unsustainable drug prices in CML and cancer may be causing harm to patients. Advocating for lower drug prices is a necessity to save the lives of patients who cannot afford them.
To this band of doctors, that means dispensing with the notion that regular market forces should play any role in the setting of cancer drug prices. Instead, the pricing should be governed by what is just and reasonable, recognizing that someone’s life may be hanging in the balance. It is no different, they argue, than what should go into the pricing of a loaf of bread during a famine, an essential vaccine like for polio, or the treatment of a chronic medical condition like diabetes or multiple sclerosis.
So what would these doctors consider to be a morally just price for cancer drugs? It would be one that provides the manufacturers with a “healthy” profit, fully accounting for the significant research and development costs that go into discovering and developing these life-saving medicines. This is an amount that they recognize can be quite steep, easily reaching a billion dollars for some of the biggest blockbuster drugs. But charging as much as the market will bear simply because the manufacturer can is no different, the doctors contend, than price gouging, or raising commodity prices (like the price of food, water or gasoline) after a natural disaster strikes. This is a practice that happens to be illegal in many states.
The problem in all of this is where to draw the proper line between pricing that is fair and affordable but sufficient to incentivize the drug-makers to take the significant financial risks inherent in pursuing these miracle cures. To this, Dr. Kantarjian and his crew have no proffer other than to get all of the various constituencies together — the FDA, patients, physicians, hospitals, insurance companies and pharmaceutical companies — to begin a much needed dialogue “to address the reasons behind high cancer drug prices and offer solutions to reduce them.”
The first step in commencing this dialogue is shining a spotlight on the problem as Dr. Kantarjian and his colleagues have done here and as Sloan-Kettering did a few months before. This kind of attention alone very well may move us down the path to more affordable pricing for cancer drugs. After all, only three weeks after Sloan-Kettering took its stand against Zaltrap in a highly publicized New York Times Op-Ed article, Sanofi, the maker of the drug, announced that it was cutting its price in half. It remains to be seen whether Dr. Kantarjian’s critique will have the same result. At the very least, it is definitely getting the industry talking about yet another critical challenge in the delivery of affordable healthcare in this country.