Rx Savings? Pay gap among cancer drugs may double in the next few years

No one knows how far affordable cancer drugs may go. But given the growing numbers of Americans living with cancer, we have to find ways to afford them. We’re hoping Friday’s announcement that Pfizer will sell enough of its oral antifungal drug ocrelizumab to the U.S. to meet demand until a $2 billion alternative is developed represents a turning point for cancer coverage.

Pfizer announced Thursday that it will sell enough of the drug ocrelizumab, or crizotinib, to treat 10 million patients in the U.S. until a $2 billion alternative, imatinib, can be developed. That gap in coverage will eventually be covered by insurance companies, and if people with commercial insurance or Medicare Part D pay for the two drugs out of pocket, they will be able to get decent coverage and a good deal at the pharmacy counter.

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Pfizer estimates that the gap in coverage will raise prices by an average of $179 for the 80% of people who take the two drugs, and that will likely mean worse quality of life.

If they do get health insurance or Medicare Part D, some people may experience a big pay gap. A South Florida clinical trial found that 62% of patients who started treatment with the cheaper drug were able to stop on their own and pay out of pocket for 30% of the people who started on the pricier drug.

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Only 1 in 5 people with cancer have insurance, and unless you have health insurance that will cover the other 62%, it may be time to start asking about a pay gap. Or you could save for six months or a year by getting two drugs instead of one.

I have it easy: I work for PBS NewsHour and freelance as a health and science writer and freelance health correspondent.

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You might have to come up with an answer before a drug isn’t on the market any longer.

There’s been a seismic shift in how pharmaceutical companies make money, and the marketplace is responding to it. If you don’t yet have good insurance that will cover the cost of new drugs, it may be time to ask about a pay gap. Or you could save for six months or a year by getting two drugs instead of one.

Meanwhile, I am always excited by a good story. You may not be. But you deserve the latest on what’s going on in health care.

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