- Drug Benefit Trends Vol 21 No 5
- Volume 21
- Issue 5
Impact of Increasing Out-of-Pocket Costs for Insured Cancer Patients
Health plans are increasingly shifting costs to plan members to share the burden of rising health care costs. A survey of the published literature and conference presentations was conducted to examine the contributors and burden of out-of-pocket costs (OPCs) for persons with diagnosed cancer. This review indicates that the OPCs for cancer patients covered by health plans are increasing and becoming a financial burden that may be exacerbated by a concomitant loss of income. Furthermore, caregivers also acquire certain costs in the care of patients, such as loss of income or prospects for career advancement. The trend toward cost shifting may also have a negative impact on patient care. Further study of this issue is warranted and should include a complete analysis of all patient costs to gauge the full impact on the quality of medical care. Health plans need to evaluate whether pursuing cost-shifting strategies is in the best interests of both patients and health plans over the long term. (Drug Benefit Trends. 2009;21:145-153)
Significant advances have been achieved in the treatment of persons with cancer, resulting in an increased survival benefit.1 Improvements in treatment across all stages of various cancers coupled with advances in screening methods offer the hope that many cancers once thought to be fatal may be treated as chronic diseases or even cured. However, innovations in treatment come at a price. The NIH estimated overall costs of cancer in 2008 at $228.1 billion. These costs break down as $93.2 billion for direct medical costs, $18.8 billion for indirect morbidity costs (cost of lost productivity because of illness), and $116.1 billion for indirect mortality costs (cost of lost productivity attributed to premature death).2 Cancer-related costs will probably continue to increase as most cancer patients are older and the baby boomer population is expected to swell the 65 years and older population from 42.5 million in 2005 to almost 70 million by 2030.3
As costs continue to climb for health plans, employers, patients, and health care providers, the plans are pursuing measures to better manage their risk. Many health plans have implemented policies to constrain drug costs, including increased cost shifting to patients through higher copayments and out-of-pocket costs (OPCs), mandating use of generics, requiring mail delivery, and expanding use of formularies. A multiyear study of 25 employers found that doubling copayments reduced overall prescription drug spending by 19% to 33%.4 Similarly, Medicaid programs with associated drug copayments were found to result in fewer prescriptions filled compared with those with no copayment.5 Such findings raise concerns about adverse health consequences resulting from cost-containment measures, particularly for persons who are chronically ill.