Balancing the Ledger: Preventing Cost From Shaping Prostate Cancer Treatment Decisions

A CANCER DIAGNOSIS HAS QUICKLY BECOME ONE OF THE COSTLIEST CONDITIONS. This year, the average cost of a newly approved cancer drug is $10,000 per month, up from $4,500 a decade ago. Recent media reports disclose the record-breaking costs of new cancer drugs. For instance, the average wholesale prices of two new medications for prostate cancer, Zytiga (abiraterone) and Xtandi (enzalutamide), are listed at $10,353 and $11,244 per month, respectively. A recently approved combination immunotherapy treatment for melanoma (Opdivo [nivolumab] plus Yervoy [ipilimumab]) has an estimated $256,000 annual price tag. These prices create real financial problems for those on limited incomes. An estimated 27 percent of survivors face significant financial hardship, ranging from large medical debt to bankruptcy. However, financial help is available to assure that patients have access to the best treatments for them. Patients should not be forced to choose between the newest, most effective treatment available and a cheaper, but possibly less effective, treatment option. No matter the diagnosis, there are patient assistance and other programs available to help relieve the financial burden of cancer.

Direct-from-the-manufacturer patient assistance programs are a great way to save and still get the best available therapy for your diagnosis. One such program, offered by the maker of the $129,000-per-year drug Xtandi, is the Astellas Access Program. This program is available to patients regardless of insurance coverage type. The company claims that 99 percent of commercially insured patients enrolled in the Xtandi Patient Savings Program pay $20 or less per prescription. Uninsured or underinsured patients who qualify may be eligible for $0 copayment. To find out if you qualify, call 1-855-8XTANDI (1-855-898-2634).

Many other pharmaceutical companies offer similar programs. The maker of Zytiga, Janssen Biotech, Inc., has a program called ZytigaOne that offers payment assistance. Speak with a support care coordinator at 1-855-ZYTIGA-1 (998-4421) for more information. Commercially insured patients whose plans cover Zytiga pay no more than $10 per month for the medication after signing up for the Instant Savings coupon card.

Most of the newest and most expensive anticancer medications are only available through specialty pharmacies. Insurance plans may require a patient to use a specific, contracted pharmacy. However, if no requirement exists, choosing a pharmacy that specializes in a certain type of therapy can be a great asset. Specialty pharmacies may have additional connections to patient assistance programs. Check with your pharmacist to see if you qualify for assistance.

Another cost-saving option is a U.S. federal government program, which is little-known outside the world of pharmacy, called the 340B Drug Pricing Program. Created in 1992, it requires drug manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices. Patients who are uninsured or underinsured receive the biggest benefit from this service. Both Zytiga and Xtandi are 340B-eligible products.

Many of the patient assistance programs are not available to Medicare patients. Fortunately, patients without supplemental coverage can receive help from independent, charitable foundations. These organizations are dedicated to helping patients afford their medications. One such foundation is CancerCare. More information can be found on the CancerCare.org website or by calling 1-800-813-HOPE (1-800-813-4673).

Another is the Patient Access Network Foundation. Its mission statement: To help underinsured people with life-threatening, chronic and rare diseases get the medications and treatment they need by paying for their out-of-pocket costs and advocating for improved access and affordability. Details on how to apply for help can be found at PANfoundation.org or by calling 1-866-316-PANF (1-866-316-7263).

Another unique way to gain access to the best available drugs may be participation in a clinical trial. The website clinicaltrials.gov is a federally run search tool for clinical trials. Search for a diagnosis and perhaps a medication type to find clinical trials of interest, entering the patient’s state of residence if staying local for treatment is important. Eligibility to participate will depend on patient criteria and how it matches up with what trial investigators are looking for. Some insurance plans may not cover “experimental” or “investigational” clinical trials. Check your plan benefits before enrolling.

Financial challenges exist, but assistance is available.

Depending on your primary insurance coverage, supplemental insurance and income level, you may qualify for reduced or zero copays for specific drugs, offered by the companies that sell them. Do not let cost keep you from getting the best treatment available. Ask your doctor or pharmacist for more information on patient assistance programs. We can help you to afford the best available medication for your diagnosis.