John Krahne received alarming news from his doctor last December. His brain tumors were stable, but his lung tumors had grown noticeably larger.
The doctor recommended a drug called Alecensa, which sells for more than $159,000 a year. Medicare would charge Krahne a $3,200 copay in December, then another $3,200 in January, as a new year of coverage kicked in.
For the first time since being diagnosed 10 years ago, Krahne, 65, decided to delay filling his prescription, hoping that his cancer wouldn’t take advantage of the lapse and wreak further havoc on his body.
With new cancer drugs commonly priced at $100,000 a year or more, Krahne’s story is becoming increasingly common. Hundreds of thousands of cancer patients are delaying care, cutting their pills in half or skipping drug treatment entirely, a Kaiser Health News examination shows.
One-quarter of all cancer patients chose not to fill a prescription due to cost, according to a 2013 study in The Oncologist. And about 20 percent filled only part of a prescription or took less than the prescribed amount. Given that more than 1.6 million Americans are likely to be diagnosed with cancer this year, that suggests 168,000 to 405,000 ration their own prescription use.
“Patients are being harmed daily” by high treatment costs, says Dr. Hagop Kantarjian, a leukemia specialist and professor at Houston’s MD Anderson Cancer Center. “It’s causing more deaths than necessary.”
For instance, one third of Medicare patients who were expected to use Gleevec — a lifesaving leukemia medication that costs up to $146,000 a year — failed to fill prescriptions within six months of diagnosis, according to a December study in the Journal of Clinical Oncology.
Stopping drugs like Gleevec could be cutting years from some patients’ lives. Instead of dying in five to seven years, patients with chronic myeloid leukemia who take Gleevec and similar drugs can survive nearly as long as people without cancer, and with a good quality of life, Kantarjian said.
Given that his lung cancer has grown slowly over the years, Krahne’s doctor thought it would be safe to wait until January to begin his new medication.
“We hope it doesn’t hurt my chance of cure,” says Krahne, from Santa Rosa, Calif. “It was an educated risk that we didn’t take lightly.”
Krahne made repeated calls to patient-assistance programs throughout January, trying to find help with his out-of-pocket costs. “The anxiety during those days or weeks was probably almost as bad as the day I was diagnosed with cancer,” Krahne says.
Doctors have a term for Krahne’s problem: “financial toxicity.”
“We’re talking about huge numbers of patients,” says Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research at the Fred Hutchinson Cancer Center in Seattle. “It’s an epidemic. And it’s not going away.”
Even patients with good insurance can face a financial crisis when trying to pay for cancer therapy. Medicare pays for the bulk of cancer care in the United States because 59 percent of cancer patients are older than 65. And although it covers a high percentage of the cost, copays for patients such as Krahne can easily reach $10,000 a year, according to Stacie Dusetzina, a researcher at the University of North Carolina who has found that privately insured patients with copays of just $53 were 70 percent more likely to stop taking Gleevec or take fewer doses than prescribed.