The Cost of Hope: 5 Things to Know about the Cost of Cancer Drugs

May 30, 2017
A look at current and future drivers of oncology medication trend, plus a solution to change the way we pay for cancer.
  • Cancer

Rochelle Article

The future of cancer care will be on display at the upcoming American Society of Clinical Oncology (ASCO) annual meeting this week. While we await news of the latest innovations in treatment, here are five things to know about the current cost of treatment and the impact on payers and patients:

1. Cancer was the third costliest therapy class for employers in 2016. Spending on oncology medications increased nearly 22%, due to growth in both utilization and unit cost, for specialty cancer medications that are covered under the pharmacy benefit.


2. The average cost per prescription for payers was $7,890.21.

3. List prices for oral oncology medications, which are not rebated or discounted to any significant extent, have doubled between 2011 and 2016, from $20 per unit to $40 per unit. Looking at the 39 medications that were on the market in 2010, six had 100-200% inflation between 2010 and 2016; one had inflation greater than 300%, and one had inflation greater than 800%.


4. Three oncology drugs accounted for nearly one-third of market share in the class: Revlimid® (lenalidomide), capecitabine, and brand and generic forms of Gleevec® (imantinib). Although there were generic savings in 2016, they did not outweigh the spend increases due to utilization and unit cost trends.


5. Looking ahead, the use of oncology medications by patients as maintenance therapy will result in increased utilization of these expensive medications. We forecast spending for cancer drugs will increase by more than 20% each year through 2019. Additionally, the increasing prevalence of self-administered oncology medications will lead to higher utilization and cost through the pharmacy benefit.

Changing the Way We Pay for Cancer

With more than 830 oncology drugs in the pipeline, effective cost management of these drugs is critical. There is no limit on innovation, but there is a limit on the resources available to pay for innovation. Fighting cancer is hard. Paying for the rising cost of drugs that treat it shouldn’t be.

Through the Oncology Care Value ProgramSM, we protect payers from unnecessary spending while ensuring patients are treated with the right drug for their condition at the right price. Indication-specific pricing aligns payment for a drug with the value it delivers and how particular patients respond to that therapy.

Most importantly, through the Oncology Care Value Program, patients with cancer receive specialized care from clinicians in the Express Scripts’ Oncology Therapeutic Resource Center (TRC). They can get advice from a dietitian, social worker and other forms of specialized care to stay on course with sometimes difficult drug regimes. Oncology patients who fill their prescriptions at Accredo® specialty pharmacy are 5% more adherent than those who fill their prescriptions at retail.

Today, cancer medications managed through the Oncology Care Value Program represent 23% of oncology pharmacy spending.

Importantly, the Oncology Care Value Program has clear, measureable results. In its first year, patients in the program, who filled their prescriptions via Accredo were 5% more adherent with their therapy compared to patients who filled their medication at a retail pharmacy. The advice and specialized care we offer to patients makes a difference.

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Lab Staff
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