If you come down with cancer you had better have health insurance. Otherwise, prepare to go bankrupt or die.
Cancer treatment has become so expensive that if you are not very rich or poor, well-insured or covered by Medicare, you will miss out on the latest breakthroughs. Anyone who is middle class and uninsured is in big trouble.
The FDA just approved a new drug for breast cancer. Tykerb is an exciting advance because it improves survival in women with aggressive tumors that no longer respond to standard treatments.
The trouble with Tykerb is that it costs about $2,900 per month and has to be given with another medicine called Xeloda that can run more than $1,500 a month.
Such prices are by no means unusual. In the last few years, drug companies have developed important new treatments for a variety of cancers. They are charging enormous amounts for these advances.
According to an analysis by Geeta Anand of the Wall Street Journal, the kidney cancer drug Sutent can cost $46,500 for the average patient. Erbitux, for colorectal cancer, can cost $10,000 per month or $40,000 for a course of treatment.
Avastin is a completely different kind of cancer treatment. It cuts off blood flow to tumors and is being prescribed to patients with colorectal, breast or lung cancer. A course of treatment can reach more than $50,000.
But even that pales in comparison to a medicine developed for a rare blood cancer called multiple myeloma. A year’s treatment with Revlimid could reach over $60,000. When it is used in combination with another new cancer drug called Velcade, the annual bill could top $100,000.
Such medicines prolong life far more effectively than classic chemotherapy. Often they are better tolerated.
The trouble is that the longer you live, the bigger the bills. Someone with myeloma could survive many years thanks to Revlimid and Velcade. A family without insurance could end up with a bill in the hundreds of thousands of dollars.
The only way to pay for such treatment is to sell your home. Even then you may only be able to afford a few years’ treatment. Ultimately, families go deeply into debt or give up.
Even with insurance, a 20 percent co-pay could represent a bill of thousands of dollars a year. Few families can come up with that kind of cash, especially if the patient is the breadwinner.
Insurance companies are no happier about these bills than patients. As a result, some payers are unlikely to cover treatments that are considered experimental.
A drug that has been approved by the Food and Drug Administration for treating one type of cancer may prove beneficial for another. But it can take years for the FDA to acknowledge this new use. In the meantime, doctors who administer a cutting-edge therapy that could prolong life may not be reimbursed by an HMO or insurance company. Few oncologists can foot this kind of bill for very long.
Drug companies may argue that life-saving therapies are worth the astronomical prices people have to pay. But when ordinary citizens, Medicare, HMOs and private insurance companies can no longer afford the bill, Congress may act to rein in the high cost of surviving cancer.
