Published on May 2, 2018
As a leukemia patient, I am watching the news about chimeric antigen receptor therapy (“CAR T-cell therapy”) with great interest as I might need it someday. Patients with many other cancers are watching too as a hope for a cure. And the FDA has been cranking out approvals for it, even today as I write this, for an expanding list of cancers. Obviously we need to weigh what’s safe and effective against cost in the real world. But “cost” is a relative term; and market forces, efficiencies, and competition can affect it over time. Read on and put it in perspective.
Last September I wrote about this “revolutionary new approach to treating cancer called CAR-T cells. Instead of chemotherapy, this removes a patient’s own cells, sends them to a laboratory and reprograms them to fight the cancer when injected back into the patient.”
FDA commissioner, Scott Gottlieb said, "We're entering a new frontier in medical innovation.”
Sam Fazeli, a Bloomberg Intelligence analyst, says it’s a paradigm shift. “We’re not used to drugs curing people with cancer.”
Now we are seeing articles like this one from the Wall Street Journal referring to “The Million Dollar Cancer Treatment – Who Will Pay?” The article takes us through, not just the cost of the CAR-T cells, but the cost of related hospital and doctor care.
A million dollars? It’s unnerving! But don’t let that distract you from the potential of CAR-T treatments and what may be that first elusive curefor many cancers.
“They put up the scans from three days before I had the (CAR-T) infusion and 30 days after. Three days before, my abdomen and half-way up my back it was bright white—there was no separation between tumors. The new scan after the treatment was dark. There was nothing.”
Patient Power interviewed B-cell Hodgkin lymphoma patient Dan Symes about the dramatic results from his treatment with the new CAR T-cell procedure. Sixteen months after his treatment, he remains in what is officially complete remission, but perhaps it will turn out to be cure.
So what should we think about a million dollar price tag?
Beware of Price Predictions
First, let’s remember that it’s a brand-new therapy and new therapies always cost more at the start. Remember that cure for hepatitis C? There were negative reports warning it would cost $1,000 per pill, but no one ever paid that! "In reality, insurers and benefit managers negotiated discounts that reduced the price of by 20 to 50 percent," according to Peter J. Pitts, former FDA associate commissioner, writing in the New York Post, September 24, 2015.
Like the Hep C therapeutic, the price for the first CAR-T therapy didn’t reach early predictions either. Analysts thought the price could be $750,000, but the manufacturer cut its price to less than $500,000. And then there’s competition. The Wall Street Journal article says a rival drug was priced about $100,000 dollars lower still. That’s still a lot of money, but the point is, it undercut the early predictions.
Pharmaceutical companies developing these potential cancer cures are dealing with price concerns in other ways. Novartis, that developed one of the first CAR-T treatments, agreed there would be no charge unless patients show early signs that the treatment is working. Patients are paying only for success.
Treating Cancer Is Expensive
CAR-T is described as a million dollar cancer treatment compared to what?
Some people pay as much as $900,000 for a stem cell transplant, now. A transplant is not necessarily a cure, and is followed by a period of intense recovery.
Or, consider that Patient Power recently interviewed a patient undergoing more conventional treatments that to-date have totaled tens of thousands of dollars. He’s still undergoing treatments, and no one knows what his final tally will be.
By contrast, CAR-T treatment could be “one and done,” leaving the patient healthy and ready to go on with their life. Dan Symes didn’t expect to live another year. Now he’s ready to retire, spend time with his young granddaughter and do all of the things he had been planning his whole life—plans that were in jeopardy before he was treated with CAR-T.
The Healthcare System Needs to Work Together
Still, the Journal says, “What is clear is that the total cost will be far more than the list price of the drugs themselves.” Administering these therapies can add hundreds of thousands of dollars to the tab, including lengthy hospital stays and use of other services and medicines. The insurance system hasn’t caught up with these complexities. It’s similar to insurers still coming to grips with oral drug parity for cancer meds taken by mouth, but we are making progress with parity laws in states across the country.
The Journal article notes, “Insurers don’t question the benefits of the treatments but say they are affordable only if the cost is spread over time. There is currently no payment mechanism to do so.” But there can be, and, if needed, there will be a different approach to paying for high-value treatments. We already pay for other large expenses such as a house or a car over extended periods of time; why not let insurance providers pay for cancer cures that way too?
Meanwhile, don’t let the headlines scare you. Those are administrative issues, and if we can cure cancer, surely we can figure out the paperwork.
I welcome your thoughts at firstname.lastname@example.org.
Co-Founder, Patient Power LLC
Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you
Your site is AWESOME! Thank you all so much for this incredible resource to families who are in crisis/affected by cancer.