By Heather Block
March 28, 2016 at 5:00 am ET
I will remain in treatment as long as I live.
There is no cure.
I have breast cancer that has metastasized into my liver and lungs. The American Cancer Society says 22 percent of those with metastatic breast cancer will survive 5 years.
I’m at 4 years and change, and I have a CT scan next week.
The scan will determine if I will remain on my current drug, or switch to yet another drug in the hopes of keeping the cancer stable. My personal Catch-22 is that while drugs are keeping me alive, I am also going through my savings at an alarming rate.
As a patient with metastatic, Stage 4 breast cancer, I encourage the government to find new approaches to pay for drugs. Patients like me shouldn’t have to choose between getting access to drugs life-saving drugs or paying our mortgage. No one should have to fear bankruptcy just as much as cancer.
I was so relieved when I found out that I qualified for Medicare, even though I was well under 65. For those unaware (as I was, pre-cancer), one can qualify for Medicare after 29 months on Social Security Disability Income (SSDI). My drugs are billed through Part B, as most cancer treatment drugs are.
My relief was short lived when I realized that the drugs are exceedingly expensive, and I am always on the hook for the 20 percent co-pay. Another trend in cancer care is drug-stacking, taking more than one drug simultaneously. Imagine that, when each can cost upwards of $10,000 per month.
There is no out-of pocket-maximum for Medicare Part B. This means I am responsible for paying 20% of every cancer drug I receive forevermore.
CMS’s latest proposal to curb the tide of rising drug prices is a 5-year evaluation, not a complete overhaul of Medicare Part B. It is measured and fair, and it’s a way for the government to begin to shift pricing practices incrementally, based on what they learn. By evaluating payment models over a five year period, CMS can determine the best practices without forcing me to change doctors, hospitals or affecting my drug coverage.
We need to assess each model’s ability to lower program expenditures while maintaining (or dare I say improving) the quality of care. How else can Medicare continue to ask me to pay for 20 percent of increasingly expensive prescription drugs without any evaluation of whether my money is being well spent? And who wants to wonder if their doctor is basing their prescribing decisions on how much they’re going to get paid rather than what’s the best course of treatment?
Yes, I love the provision that limits cost sharing to the current 20 percent, or can even be reduced or waived entirely. These proposals simply put new options on the table to evaluate value-based purchasing tools that are already being used in the private sector. As a taxpayer and a patient, this is exactly what I want our government to be doing – getting the best value for our money.
Frankly, we need to start somewhere. The price of drugs is not sustainable. These approaches are a step in the right direction – and one we can no longer ignore.
Please let me say this as plainly as possible: drug innovation is meaningless without affordability. These proposals reflect a government working to address this issue, and I applaud them.
Heather Block ran international projects for the U.S. Government, United Nations and various nongovernmental organizations in over 30 countries. She was diagnosed with cancer while working in Afghanistan.