Will the National Comprehensive Cancer Network leave common sense in San Francisco?

At its 10th Annual Congress and practically in the shadow of the Golden Gate Bridge, the National Comprehensive Cancer Network is the latest organization to enter the feeding frenzy over pharmaceutical pricing. But will the National Comprehensive Cancer Network leave its common sense – to say nothing of its heart – in San Francisco?

The organization that provides important treatment guidance derived from clinical studies and experience is now apparently scotch-taping price to its evaluation criteria – it’s likely not a great fit. Patients Rising not only welcomes a thorough discussion of treatment costs, we believe it’s long overdue and must include all of the major players and accomplish definable goals:

  • It must compare the cost and potential side effects of pharmaceuticals to invasive procedures including surgery and transplants.
  • It must include savings to the healthcare system from advanced medications vs. hospitalizations – the “value of innovation” that we’ve written about before.
  • It must include various reimbursement structures, as National Comprehensive Cancer Network’s guidelines reportedly do not account for how much of the cost insurance will cover.
  • Reform of the terribly flawed 340B program that too often means a windfall for hospitals from discount drugs for the poor.

If a cost crisis exists, it would seem to be attached to the fact that many patients pay more out-of-pocket because insurance puts cancer medications on a high tier, and savings negotiated by pharmaceutical benefits managers are not always passed on to patients. In many cases they pocket the savings themselves, according to former FDA associate commissioner Peter Pitts.

This could easily be aimed as Express Scripts Holding Co. and its scheme to price cancer drugs separately for each indication is not in the best interest of patients, only the company’s bottom line.

Interestingly, at ASCO two years ago, even the insurance industry complained that the price of a medication administered by a medical practice jumped after it was purchased by a hospital. Same doctors, same patients, same medications – but a new price charged to insurance by the hospital. Where are National Comprehensive Cancer Network’s guidelines for that?

Let’s remember also that cancer medications are less than one percent of healthcare spending. Maybe we need to start looking at hospitals that account for a third of healthcare spending? Many of them are members of NCCN, like the Mayo Clinic where 118 oncologists recently took to the prestigious pages of Mayo Clinic Proceedings to call for government-mandated price controls of cancer therapies. Is that the next guideline?

National Comprehensive Cancer Network’s “Evidence Blocks” adding affordability to the list of criteria to consider alongside, efficacy, safety and tolerability are due to be released today for certain blood cancers. Guidelines for solid tumors, including breast, lung and colon cancers, are expected next year. We’ll be commenting on specific guidelines as they are released and after we’ve reviewed them with patients.

By all means, let’s talk about price, but within a comprehensive discussion. To focus only on one aspect of the cost issue while ignoring others is incomplete, ill-advised and leads inevitably to the kind of finger-pointing and fuzzy math that has yet to treat or cure a single patient.

Maybe we need new guidelines to help point National Comprehensive Cancer Network in a patient-centered direction. We’ll be watching.

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