By Mark Scholz, MD
I have never seen a real game of chicken where two cars race head on toward each other to see who will swerve first, i.e., who is chicken. However, we are seeing an actual game of chicken being played out before our eyes on the national stage.
In one car in this are the pharmaceutical companies that are charging mind-boggling prices for their new cancer drugs. FDA approval of a new medicine is like hitting the lottery because the insurance companies are legally obligated to pay for the drug. Recouping the cost of developing a new drug is certainly justifiable. Even so, in my recent blog I cited the example of Zytiga (abiraterone), an effective new pill for prostate cancer that retails for $5,000.00 per month.
The other car in this game is the insurance companies, who, to control costs, have begun imposing artificial restrictions on coverage of Zytiga by insisting that chemotherapy be administered first, before Zytiga can be prescribed. By imposing this artificial restriction the insurance companies are getting involved in making decisions about treatment that historically have been left to the doctor. The insurance company’s rationale is that the studies of Zytiga that led to FDA approval were performed in men after chemotherapy, so in theory we don’t know if Zytiga will work before chemotherapy. What a travesty! Any cancer expert—for that matter, anyone with common sense—can tell you that starting treatment earlier works better than waiting until the disease is more advanced.
I really don’t know how this scary game of chicken is going to end. No insurance company has endless resources. Yet, thanks to effective research being performed by the pharmaceutical companies, many new (and expensive) drugs are coming on the market. Presently in my daily practice, people who meet the criteria—men who have had previous chemotherapy—and have adequate pharmaceutical insurance, are getting coverage for their Zytiga pills. Also, Johnson and Johnson, the manufacturer of Zytiga has a generous program for drug access for people who can’t afford the drug. Even so, at some point the costs to society are going to become unsustainable. Just like the game of chicken, if both the parties wait too long to take corrective action, we can anticipate a crash.
More about Dr. Scholz:
A board-certified medical oncologist, Mark C. Scholz, MD, serves as medical director of Prostate Oncology Specialists Inc. in Marina del Rey, CA, a medical practice exclusively focused on prostate cancer. He is also the executive director of the Prostate Cancer Research Institute. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center. He is the co-author of the book Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Potency. He is a strong advocate for patient empowerment.