Expensive cancer drugs with modest benefit ignite debate over solutions.

L ike many oncologists, Don Dizon, M.D., doesn’t like to candy-coat bad news. “I try to be realistic about what we can accomplish with treatment,” said Dizon, who specializes in treating gynecological cancers at Women and Infants Hospital of Rhode Island. But it’s in what he tells his patients afterward that Dizon may stray from the norm. Dizon also discusses with his patients the cost of drugs and the fact that their particular insurance may not cover them. Patients then meet with a hospital-appointed nurse manager, who not only explains chemotherapy to them but also helps them navigate the morass of health insurance coverage in the U.S. The nurse manager is responsible for fi guring out whether a prescribed course of therapy will be covered by a patient’s insurance. And if it isn’t, that patient is sent to a hospital-appointed fi nancial counselor who then explains that if insurance won’t pay, the patient is responsible for all costs. Welcome to the new world of cancer care. As pharmaceutical companies charge ever-higher prices for new drugs, American health care insurers have responded by tightening their belts. Many are denying payment for treatments that aren’t backed by clinical evidence. Others are asking patients to share a portion of the costs. Consequently, oncologists can no longer focus only on prescribing the best therapy; they must also consider the price tag. Moreover, hospitals and other facilities that treat cancer have had to hire additional staff to navigate the stony path of reimbursement. “Things have changed a lot,” said AnneMarie Bradley, a nurse manager at Women and Infants Hospital who has worked there for 22 years. Oncology isn’t the only medical discipline affected by high drug prices. But the fi eld has been especially hard hit by belttightening policies because most new cancer drugs have a modest, sometimes minimal, benefi t. “In oncology, we’re looking at a lot of drugs that extend life by a matter of months. We are in the gray zone in terms of benefi t,” said Jane Weeks, M.D., Ph.D., a professor in the department of health policy and management at Harvard School of Public Health. “High costs are harder to justify.” Even though experts agree that expensive drugs with modest benefi ts present a huge dilemma in healthcare, few see signs of positive change.