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Patients Rising

Progress Through Politics

There is a grave disconnect between medical science and government policy. On a national level, closing that gap certainly seems to be a bridge too far, but on a state level, we are making connections – bi-partisan connections - to achieve what we call the right treatment, for the right patient, right now.



When it comes to the science of cancer, important discoveries are occurring in every area of research. Perhaps one of the most promising is the excitement over new immunotherapies that train a patient’s immune system to directly seek and destroy the cancer. Another exciting advance is the increasing ability to target therapies to the unique molecular and genetic characteristics of each specifi c cancer. In just one subset of lung cancer alone, as many as 15 genetic alterations have been identified, and for each of them specific treatments have been approved or are in development.

Yet, for cancer patients, developing new immune therapies or targeted treatments is not enough. They need access to these life-saving discoveries. The problem is, ready access to effective new therapies is not assured.

When breakthrough cancer therapies reach the U.S. market, tens of thousands of cancer patients are confronted with rising copays, restricted coverage and all too often, insurance practices that deny access completely. Adding to these barriers, now there are so-called “value frameworks” that rate cancer therapies against an arbitrary and often irrelevant monetary benchmark. We call that the “original sin” of public policy. And it’s downright frightening.

Remember, many of these cancer mutations involve small groups of patients, sometimes as little as one percent of patients within that subtype. But it costs as much to develop, test and approve targeted treatments for the one percent as for blockbuster treatments where the costs can be spread across tens of millions of patients.

Further evidence suggests that health systems that invest more spending in new innovative therapies had lower cancer mortality rates versus their lower spending counterparts. Countries that increased spending the most had a 17 percent decrease in mortality, compared to eight percent in the countries with the lowest growth in cancer spending. This demonstrates the link between higher cancer spending and lower mortality rates and is a testament to the importance in investing in healthcare

Politicians of all stripes should work together to help ensure that patients receive the benefits of the breakthrough therapies they need. And at the state level they’ve shown us they can do just that.

Over the past several years, policymakers in 39 states and Washington D.C. have voted yes for pro-patient policies that would eliminate an outdated practice that required larger out-of-pocket payments for pills and capsules to treat cancer, while providing larger reimbursement for a needle stuck in the patient’s arm. That made no sense, but it’s a battle we’re still fighting.

And that’s just the beginning.

For example, in California late last year, the legislature passed a law allowing a way around so-called step-therapy. That’s where insurance policies require patients to take an older, cheaper drug first. The bill’s author said in some instances patients have to try fi ve different medications, and then “fail” on them all before they’re allowed to get the therapeutic their doctor prescribed. And what’s most exciting to us, this legislative achievement was the result of a bi-partisan effort to provide a way out of this practice.

As a nonprofit organization working to improve access to effective cancer care, Patients Rising believes patients should not be forced to fight the system and their cancer at the same time. We call on legislators and regulators to work together with patients, caregivers and physicians to provide faster and easier access to the latest medications – and do so in a responsible manner that prioritizes patient safety and the integrity of new drug evaluations.

It’s time for national policies and every business and industry involved with healthcare to agree: The right patient should have access to the right medicine at the right time.

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