June 7, 2019

The Growing Utilization and Costs of Anticancer Medications

The Journal of the American Medical Association (JAMA) recently published a report that assessed the point-of-sale prices from 2010-2018 for orally administered anticancer drugs offered through Medicare Part D.

In 2013, only 12 anticancer drugs were covered by Medicare Part D, but by 2018 that number jumped to 54. Regarding cost, 48 out of 54 of those medications had monthly prices exceeding $10,000 per fill, and 21 had prices exceeding $15,000 per fill. Overall, the mean price per monthly fill in 2010 was $7,438, increasing to $13,992 in 2018. Since 2010, changes in per-fill price increased 40.4% overall.

While cancer is not the most common condition found in workers’ comp claims, it is prevalent enough that drug trends impacting cancer can make serious waves.

Occupational cancers can occur due to exposure to cancer-causing agents in the workplace environment, and it is estimated that 4% of all U.S. cancer cases are caused by occupational exposure. In fact, the Centers for Disease Control and Prevention (CDC) estimates that between 46,000-92,000 new U.S. cancer cases in 2012 were attributable to occupational exposure.

Furthermore, there is a strong legislative push for workers’ comp to cover more and more types of cancer for firefighters who are regularly exposed to known or suspected carcinogens on the job. If trends such as these continue to grow, comp programs will need to further familiarize themselves with cancer medications and create strategies to manage their utilization.

With pharmaceutical R&D growing more specialized, more and more oncology drugs are entering the market, dominating new drug approvals. And these drugs certainly have a market. IQVIA found that the number of patients on immune-oncology drugs doubled from 2016 to 2018, reaching 200,000. As this drug trend grows over time, it is very likely to impact workers’ comp.

Healthesystems has previously discussed how specialty drug trends, including the ongoing development of new cancer medications, are impacting workers’ comp, as well as treatment decision points for these specialty medications.

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