Despite the rising cost of drugs, including targeted therapy, immunotherapy, and non-oncology drugs such as the new drug for Alzheimer’s disease, which costs $54K per infusion, the fact is: drug cost consumes 19% of the total health care cost. That is high and has increased by 2% in the last four years.
The devil is in the details. The cost calculation is based on what is paid by insurance, not the cost from manufacturers. That is the tricky part that hospitals and academic centers have succeeded in confusing the public and even the astute policymakers. Examples tell a story. Examples are no longer anecdotes; they are becoming the standard of what we see. We at Gabrail Cancer Center have a side business model based on a book I wrote 13 years ago titled “Good Medicine is Cheaper Medicine.” That book triggered a friend and me to start a primary care clinic at the worksites in factories and large businesses. It has been a great business model, an educational program, and very cost-effective service for employers. We are painfully learning that large hospital conglomerates and academic centers are indeed the cause of rising health care costs in general and drug costs in particular. For example, medicare pays $2,097.00 for a Remicade infusion when delivered at a free-standing community infusion center such as ours. Yet the next-door academic center, a misnomer as it could be called a money-laundering center, charges and gets paid $19,000 per infusion. That is one example of hundreds or thousands. Yet, when employers complain, the scientific-academic complex responds, “we are safer,” really…? Being close to academic centers geographically, we have learned to our disgust that the inflationary force behind increasing drug costs is not the actual price set by pharma- to some extent, it is, but when academic centers bill 10-fold what Medicare pays, we have a severe problem. It is puzzling that this has been going on for decades, yet it is grabbing no attention. As my friend Dr. Keith Lerro mentioned in a previous blog, hospitals and academia are good salesmen and women. They claim the untrue, they slander community physicians, and they get away with it. It is frustrating, especially when our policymakers hibernate in their pit holes, putting a thin veil on their faces refusing to face the problems we have, problems that can easily be solved if there is a will and understanding of logic. While we can’t change the politician’s mindset or guide academia to be scientific, we have decided to go to the people who write and sign the checks, the employers, and we have succeeded partially. We only succeed when people think outside the conventional wisdom. So, we have succeeded in diverting infusions from academic centers to our center, and employers are happy to see 700% savings on expensive drugs. The hope is that our advocacy groups will propagate these ideas and expose the abuse of the health care system by academia and large hospitals- but alas, we in community oncology and our patients have no influential advocacy group. Instead, we have organizations that care more about how much money they get from Pharma and insurance companies and have no interest in exposing the abuses that hamper access to care because of the sinful exorbitant cost. We at ICOP are not only fighting to save community oncology, which is the icon of cost-effective, accessible, and superb care, but we are fighting for access to care for all cancer patients. Nashat Y Gabrail M.D.