More pressure to justify cost of cancer drugs versus benefits
A sign is displayed in front of the Genentech headquarters July 14, 2008 in South San Francisco, California. This company relied on the popularity of its cancer drug Avastin to boost profits. (Justin Sullivan, Getty Images / December 13, 2012)
"These drugs are the backbone of many therapies recommended by the National Comprehensive Cancer Network (NCCN) ... and typically much less expensive than their brand counterparts," said Jennifer Malin, WellPoint's medical director oncology.
She said the goal is to shift the system away from what has been a largely drug-revenue based practice model, to one where oncologists are paid for providing good patient-centered care.
"The payers are looking at the quality data and demanding incremental value over existing products," said Dan Mendelson, chief executive officer of consulting firm Avalere Health.
"COKE DIDN'T WORK, SO LET'S TRY PEPSI"
Zaltrap was approved in August by the Food and Drug Administration after a study found it improved survival, in combination with chemotherapy, by 1.4 months in colon cancer patients who had stopped responding to chemo.
That is the same benefit seen with Avastin, sold by Roche Holding AG for around $5,000 a month, or about half the price of Zaltrap.
NCCN guidelines say either one or the other drug should be used, not both, but Dr Saltz said most Zaltrap use is likely in patients who were already treated with Avastin - a practice that insurers will eventually stop.
"It's like saying Coke didn't work so let's try Pepsi," he said.
As scientists unravel the biological underpinnings of cancer cells, new targeted therapies are being developed, but the process is expensive.
Dr. Saltz said the solution might just be to walk away from drugs with small, incremental benefits.
"We simply can't afford to pay these very, very large amounts for drugs that offer most people very small benefit," Dr Saltz said. "We haven't figured out how to rein it in."
(Editing by Andre Grenon)