Lower drug prices won’t fix cancer care

After former President Jimmy Carter used the cancer drug Keytruda — which ultimately helped him become the first U.S. president to live to 100 — cancer patients across the United States had one request for their doctors: “I want what Jimmy Carter had.”

But not everyone who wanted the treatment could get it. Some patients had cancers that weren’t treatable with the drug. Other patients were good fits for the breakthrough immunotherapy, but still struggled to access it, because their insurers threw up roadblocks or demanded high out-of-pocket payments.

Yet in response to these problems, policymakers often narrowly focus on lowering the prices that insurers pay — without any guarantee that patients would actually see savings or better coverage. Instead, it would be far wiser for policymakers to focus on directly strengthening the social safety net, so every patient has equitable access to treatments without financial hardship.

Doctors often hail immunotherapies as miracle drugs — and for good reason. Unlike chemotherapy, which kills healthy and cancerous cells alike, these medicines essentially empower patients’ immune systems to correctly recognize and attack tumors. They’re highly effective across a wide range of cancers, completely changing many patients’ lives.

Cancer drugs like these can cost well over $100,000 for a year’s course of treatment. Even with insurance, many patients struggle to pay for the care they need. According to the American Cancer Society Cancer Action Network, six in 10 cancer patients say that it’s somewhat or very difficult to afford care, with over 80% saying they’ve had to make financial sacrifices to cover health expenses.

In response, some policymakers and advocates have called for government action to forcibly lower the price of breakthrough drugs. But while they undoubtedly have good intentions, their focus is misplaced.

Many patients currently struggle to access treatment because insurers frequently deny or delay cancer care. One study found that over 20% of cancer patients do not receive necessary treatment because of prior authorization requirements. Those delays or denials lead to serious adverse events nearly 15% of the time.

Doctors are sounding the alarm. One medical oncologist in South Carolina, for example, took to social media to report that insurance company Humana was denying his lung cancer patient Keytruda. The company demanded that the doctor use a different drug instead. Other physicians have described similar denials or reported insurers denying continuation of treatment, prompting some to publicly petition insurance companies.

In these kinds of cases, family members are often left asking an unthinkable question: Would their loved one still be alive if they’d received the necessary care?

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Price controls would not solve these coverage failures. In fact, they’d almost certainly make the situation worse by undermining the research ecosystem.

Developing a new drug takes more than a decade and costs up to $2.6 billion. Companies only make that kind of investment if they can recoup those costs when a treatment proves successful and continue to invest in breakthrough drugs. Artificially lowering prices makes it harder for companies to justify taking the kinds of risks that lead to transformative medicines.

As a result, lawmakers who rush to make drugs cheaper in the short term could prevent researchers from developing more “miracle drugs” for patients in the future. That certainly doesn’t help vulnerable cancer patients.

Innovative drugs are expensive. That’s unavoidable.

But there’s no inherent reason why patients need to disproportionately shoulder those costs. If policymakers instead focus on strengthening insurance coverage and preventing insurers from denying or delaying access to breakthrough treatments, patients could have equitable access to the miracle drugs of today — and tomorrow.