Costs put cancer docs in financial bind

Pricey cancer meds aren't just putting the squeeze on patients and insurers. They're putting oncologists in a financial quandary as well. We got an inkling of this recently when the American Society of Clinical Oncology convened a task force to help guide doctors in discussing treatment costs with patients. At the time we saw that rising drug costs were starting to affect treatment decisions; a 2007 survey found that 23 percent always or most always figured cost into those choice, and 86 percent felt it their duty to consider the impact of treatment on a patient's finances.

Perhaps the next survey should measure how many oncologists-in-arrears have had to beg wholesalers to continue sending cancer meds. Or how many are sending patients to nearby hospitals for drug infusions because they can't bear the costs themselves. Or how many are millions of dollars in debt to their drug suppliers.

The problem is obvious: With expensive cancer meds such as Genentech's Avastin and Tarceva, Abraxis's Abraxane, and ImClone's Erbitux, patients have to foot the bill for thousands of dollars in copays over the course of their treatments, and digging up that money isn't easy for some people--so they're slow to pay. Private insurers turn around their reimbursements slowly, say 90 days or so. And after decades of allowing 50 percent markups on some chemo meds, Medicare cut IV drug margins to 6 percent. (FYI, the most expensive drugs were only ever marked up by 10 or 15 percent.)

Now, it's tough to weep for an oncologist whose pay isn't growing when that pay already amounts to an average of $360,000 per year. But with more and more oncology practices deep in debt and many of them forced to dun very sick patients for their payments, treatment can suffer. And the monetary woes of cancer docs just emphasize the fact that the debate over funding healthcare in general and pricey drugs in particular is far from over.

- read the Wall Street Journal article

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