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Medicare Patients Can’t Afford Life-saving Cancer Medications

— July 22, 2022

Cancer drugs are too expensive for most to seek treatment.

About one in three Americans on Medicare who don’t qualify for low-income subsidies don’t fill prescriptions for their cancer medications, according to a recent study in the journal Health Affairs.  Low income is defined as around “$15,000 a year for an individual or about $30,000 a year for a married couple,” according to the Social Security Administration (SSA).  This means, as many as “1 in 3 Americans on Medicare who don’t qualify for subsidies don’t fill their prescriptions for their cancer drugs,” data shows.

One such example is New York resident, Lynn Scarfuto, 72, who spent several years helping patients through their struggles with cancer before becoming a cancer patient herself.  She was diagnosed with leukemia in 2012 and, six years later, she was diagnosed with lung cancer.

Imbruvica, a cancer medication prescribed by Scarfuto’s doctor, carries a wholesale price tag of $16,000 a month.  Scarfuto is on Medicare but doesn’t qualify for a low-income subsidy, so her out-of-pocket comes to $12,000 a year.

Medicare Patients Can't Afford Life-saving Cancer Medications
Photo by SHVETS Production from Pexels

“How the hell are you supposed to live?  I don’t have that kind of money,” said Scarfuto, frustratedly. She has had to pull from her retirement savings (which she luckily had tucked away).

“The out-of-pocket expense for the drugs is too high,” agreed Stacie Dusetzina, the study’s lead author and a health policy professor at Vanderbilt University Medical Center. “In some cases, patients would need to shell out nearly half their gross income to be able to afford their medications.”

She said that’s “unbelievable,” adding, “Never mind the many doctors’ visits and other treatments that patients probably need at the same time.”

Congress has proposed a number of changes to laws regarding prescription drug pricing but, so far, none have taken off.  Democratic lawmakers are supposedly now pushing for a deal that would allow the government to negotiate lower fees on behalf of Medicare.  This could lower drug prices for patients, which is particularly important for medications that have to be taken to save lives.

“For cancer patients, the dilemma is especially dire because there are usually few lower-cost treatment alternatives,” said Nishwant Swami, a researcher at the University of Massachusetts Medical.

In June, Swami presented data at the American Society of Clinical Oncology meeting that found “nonwhite Hispanic cancer survivors in the U.S. reported higher rates of financial stress than white cancer survivors.”

“About 70% of Mexican Americans, in particular, reported they could not afford their expenses,” he said.

Researchers warn that “financial toxicity,” as it’s called, affects every aspect of a person, from their mental and emotional health to their physical well-being.  This could make symptoms worse and speed up the progression of disease.

“Right now, the negotiating process for lower costs is just completely a black box,” said Juliette Cubanski, deputy director of the program on Medicare policy at the Kaiser Family Foundation.

“It’s really fundamentally a life issue that we really need to be changing,” added Swami.  If drug prices aren’t lowered, Medicare patients will continue to face life and death situations that may be made less threatening with medication.


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