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Lowering the High Cost of Cancer Drugs—IV

      To the Editor:
      The astonishing cost of selected drugs to treat cancer
      • Tefferi A.
      • Kantarjian H.
      • Rajkumar S.V.
      • et al.
      In support of a patient-driven initiative and petition to lower the high price of cancer drugs.
      also extends to medications used in the supportive care of patients with cancer. A recent phase 3 placebo-controlled study of liquid doxepin (a tricyclic antidepressant drug) for painful stomatitis related to cancer treatment found a highly significant benefit for doxepin.
      • Leenstra J.L.
      • Miller R.C.
      • Qin R.
      • et al.
      Doxepin rinse versus placebo in the treatment of acute oral mucositis pain in patients receiving head and neck radiotherapy with or without chemotherapy: a phase III, randomized, double-blind trial (NCCTG-N09C6 [Alliance]).
      After the results of this study became available, I started to prescribe doxepin regularly for this indication. Initially, my patients had some problems with insurance denial because treatment of stomatitis with doxepin is not a US Food and Drug Administration–approved indication. One of the resident physicians in our radiation oncology training program suggested that I use the Internet site GoodRx.com to help my patients find the best price for this and other medications.
      Using this simple Internet tool has been an education in a dysfunctional market. The difference in price that patients pay for prescriptions, depending on which pharmacy they use, is extraordinary. I regularly see discounts of 90% or more when the least expensive price is compared with the most expensive price. A recent search for a 10-day supply of the antiemetic ondansetron, for example, revealed a minimum price of $13.90 and a maximum price of $172 (US dollars) (ie, a 92% discount) (Figure).

      GoodRx website. www.Goodrx.com. Accessed October 16, 2015.

      By using this site, I can often make insurance coverage a nonissue for patients. The least expensive price for a medication is often very affordable, even if it is not covered by insurance.
      Figure thumbnail gr1
      FigureResults of a price search for a 10-day supply of the antiemetic ondansetron using GoodRx.com.
      From Goodrx.com,

      GoodRx website. www.Goodrx.com. Accessed October 16, 2015.

      with permission.
      I cannot think of another industry in which a retailer would be able to regularly charge an exorbitant premium for a product that is readily available from a competitor for 5% to 10% of the cost. The only possible comparison I can think of is the premium paid for luxury items (eg, jewelry, luggage, perfume, beverages), but even then, most buyers know that they are paying a premium for a name.
      The high cost of medication is symptomatic of an industry in which the price of a product is never, or at least rarely, provided at the point of sale. It represents a failure of a market. I recently wanted to prescribe samarium, a radionuclide used in the treatment of selected patients with symptomatic osseous metastases. The patient wanted to know the cost. It took about a day to get this information. After the information was provided, it was clear that it did not include any ancillary fees. I asked if I could have the cost including ancillary fees (such as the fee for starting an intravenous line). I was at first told that it would take a while to even find the person who would know this. It was, in fact, another day before I had my answer.
      I now regularly use GoodRx.com to help my patients find the best price for a medication. My experience indicates that physicians and other health care professionals can use readily available tools to dramatically reduce the cost of selected medications for patients.

      References

        • Tefferi A.
        • Kantarjian H.
        • Rajkumar S.V.
        • et al.
        In support of a patient-driven initiative and petition to lower the high price of cancer drugs.
        Mayo Clin Proc. 2015; 90: 996-1000
        • Leenstra J.L.
        • Miller R.C.
        • Qin R.
        • et al.
        Doxepin rinse versus placebo in the treatment of acute oral mucositis pain in patients receiving head and neck radiotherapy with or without chemotherapy: a phase III, randomized, double-blind trial (NCCTG-N09C6 [Alliance]).
        J Clin Oncol. 2014; 32: 1571-1577
      1. GoodRx website. www.Goodrx.com. Accessed October 16, 2015.

      Linked Article

      • In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs
        Mayo Clinic ProceedingsVol. 90Issue 8
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          The high prices of cancer drugs are affecting the care of patients with cancer and our health care system.1 In the United States, the average price of new cancer drugs increased 5- to 10-fold over 15 years, to more than $100,000 per year in 2012. A study by Howard et al2 documented the escalation in cancer drug prices by an average of $8500 a year over the past 15 years. The cost of drugs for each additional year lived (after adjusting for inflation) has increased from $54,000 in 1995 to $207,000 in 2013.
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      • In Reply—Lowering the High Cost of Cancer Drugs
        Mayo Clinic ProceedingsVol. 91Issue 3
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          We thank our colleagues for their perspectives on our commentary.1 We agree with the comments of Drs Braillon and Martenson, and we thank Dr Messori and coauthors for their thoughtful analysis.
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