Off-label Use of Cancer Drugs

Business Week has an excellent article on Cancer Drugs. Did you know that most insurers do NOT cover the use of cancer drugs for forms of cancer other than what they were approved for:

... Avastin costs anywhere from $4,400 to $8,800 a month. The drug has Food & Drug Administration approval only for the treatment of colon cancer, so many insurers are refusing to pay for its use against breast and lung cancer. "It is naive to think that a patient's ability to pay wouldn't affect the practice of medicine," says Dr. Neal J. Meropol of Fox Chase Cancer Center in Philadelphia.

Cancer has always been an expensive disease, but the stratospheric prices of the newest drugs are injecting cost into treatment decisions to a degree rarely seen before. As a result, some doctors, patients, and even whole nations are beginning to reject the latest treatments, no matter how effective.

Drug companies argue that the high prices are necessary to offset development costs of these complex drugs. They also note that the newer products are more effective and safer. Before these were available, "the patients died quickly, so their treatment didn't impact the cost of health care," says Ian T. Clark, head of Genentech's commercial operations.

... Insurers are watching this trend with alarm. Most drugs are only prescribed for FDA-approved uses, but oncologists routinely administer cancer drugs for unapproved, or off-label, uses if supported by clinical trial data. Medicare is required to pay for most off-label cancer treatments, and private insurers used to follow suit, but recently they have started to balk. Morgan Stanley surveyed 100 U.S. oncologists in December and found that their off-label use of Avastin for breast and lung cancer was very low, even though clinical data showed the drug could improve survival for those diseases. The doctors said they expect to step up their use of Avastin once they are assured of reimbursement. "We're finally beginning to see some pushback on off-label uses,"says Dr. Steven Harr, a Morgan Stanley analyst

I think safety is an important concern, but most Oncologists are responsible and are looking out for their patients' best interests. Cancer research and treatments change rapidly, we need insurance companies who are willing to trust Oncologists when it comes to prescribing medications. For most people, these drugs are simply too expensive without insurance, and in some cases, it is literally a matter of life and death.