Patients generally prefer pills and capsules to injections or intravenous drug administration. The cost to the system is lower, too, because oral meds don’t require pricey self-injectors and can be taken at home, rather than in a doctor’s office or hospital. Drug companies are happy, too, because the convenience of oral meds dramatically increases the sales potential.
Therefore it should be great news for cancer patients that more oral formulations are coming to market. Yet in Cancer Pills Prompt Compliance Worries, the Wall Street Journal addresses a potential downside: patients who are prescribed oral medications for cancer may be less apt to adhere to their regimens. [For some reason I can’t find this article online yet.]
The lack of patient discipline in oral therapies could have business implications, but doctors warn about more serious health consequences.
“You’ve got a very specific window of time in which you’ve got to take these drugs or they’re not going to work,” [oncologist Angela] DiMichele said.
She said that not taking the drugs as prescribed often leads to health-care cost increases as a result of more physician and hospital visits –not to mention the distortion of clinical trial data.
Dr. DeMichele also worries that skipping doeses will cause disease resistance –as happens in HIV treatments– and lead to development of more aggressive cancers.
There are a variety of reasons for this “lack of patient discipline.”
- Inconvenient dosing schedules
- Side effects and toxicity
- Forgetfulness or lack of understanding by patients of the importance of adherence
- Benefit design: oral drugs are often covered in the pharmacy benefit, which means co-pays, donut holes and the like
- Overall cost: the patient contribution is too high, so people skip doses or abandon therapy
These are all thorny issues, but there’s really no excuse not to resolve the last two. One way to do so would be by adjusting the pricing model for the drugs. Rather than charging a fixed amount per prescription, why not switch to a software licensing model? A patient would receive a license to use the medication for the full course of their treatment in exchange for a one-time fee, and then receive whatever product they need over that time frame. The patient could pay his or her share up front or it could be subsidized by someone else if the cost is a problem. Either way the financial concern would be addressed at the start and wouldn’t have to be dealt with over the course of treatment.
Fixed costs represent a very high percentage of the total cost of supplying the drug, so it doesn’t really matter whether the patient needs a few or many refills. The model could be taken a step further by providing some kind of a financial or other incentive to patients who demonstrate adherence to their regimen once the license is established. That could aid in to a resolution of the first three issues.June 10, 2009