What do insurance companies do when confronting the high cost of high-tech drugs? The same thing government payers do: They look for ways to cut those costs without making anyone too angry. Of course, we see the government debates over cancer remedies and other potentially lifesaving treatments; just think of the U.K.'s National Institute for Health and Clinical Excellence. The private battles are less, well, public.
In both cases, the key question is how to put a value on life, as the Wall Street Journal Health Blog reports. Some of the most expensive meds only deliver a few months of survival--or even just a few months of time when cancer doesn't grow, without extending a patient's lifetime. But drugs can work very well in some and not so well in others, so it's tough to make blanket decisions that affect everyone.
In addition, public and private payers both want more data on the performance of high-tech drugs. But it can be tough to get that info. Especially, as UnitedHealth's Lee Newcomer says, from doctors. His company has been trying to get oncologists to submit data on drug performance in their patients. But the doctors don't want to deliver it. "There's fear that they may not like what they find there," Newcomer says (as quoted by the Health Blog).
Of course, one big source of revenue for oncology practices is drugs. Clinics buy the meds from drugmakers and resell them to patients. So doctors have a vested interest in assuming that expensive drugs are working. Which brings us to another thing public and private payers share when trying to figure out how to use--and pay for--pricey meds: They both face plenty of opposition.
- read the Health Blog post
ALSO: The same mechanism that makes Amgen's new bone drug denosumab (Prolia) an effective treatment for osteoporosis may also mean it could help prevent breast cancer, scientists say. Report