In an editorial on November 13, the New York Times commended Memorial Sloan-Kettering Cancer Center for taking a leadership position on drug pricing.
By refusing to approve the use of a new colorectal cancer drug at the hospital because of the drug’s high cost and lack of apparent superiority over similar therapies, the editorial indicates, the institution has taken an “unusually bold stand.”
Memorial Sloan-Kettering had signaled its decision through a New York Times op-ed article in October. The drug, called Zaltrap®, “has proved to be no better than a similar medication we already have for advanced colorectal cancer,” wrote Peter B. Bach, Director of the Center for Health Policy and Outcomes; Leonard B. Saltz, Chief of the Gastrointestinal Service; and Robert E. Wittes, Physician-in-Chief.
The companies that market the drug subsequently announced that they would effectively reduce the drug price by 50 percent by providing a discount to physicians and hospitals.
Pricing Questions Remain
Although they welcome the drug company’s decision to act, Dr. Saltz and the other physicians continue to question whether the price reduction will actually translate into a drop in Medicare reimbursements or copayments for patients — both of which are tied to the wholesale cost of the drug.
“Another problem with offering a discount without changing the official price of the drug is that this could inadvertently create a financial inducement for providers to choose that drug,” Dr. Saltz explains. “If the providers are getting a 50 percent discount but are still being reimbursed at the full price, prescribing Zaltrap could result in significant profits.”
Zaltrap appears to offer the same survival benefit as an older drug, Avastin®, which works in a similar way, but Zaltrap costs more than twice as much. Neither drug is used alone, and both drugs show modest activity when added to chemotherapy.
Behind the Decision
In making their decision, the physicians indicated that not just the benefits that treatments may deliver but the “financial strains they may cause” need to be taken into consideration in each case.
“Ignoring the cost of care … is no longer tenable,” they wrote in the op-ed. “Soaring spending has presented the medical community with a new obligation.”
Many other cancer experts voiced their agreement. Responding in a letter to the editor, Sandra M. Swain, President of the American Society of Clinical Oncology, praised Memorial Sloan-Kettering’s decision for reflecting “a much-needed willingness to address the elephant in the room: unsustainable costs in cancer care.”
“It is a heartening sign that alert and aggressive physicians can potentially play a major role in helping to reduce the escalating costs of health care for treatments of marginal value,” the Times concurred in its November 13 editorial. “Sloan-Kettering has shown what the medical profession can do to reduce costs if it has a mind to.”