AYERS: Tamoxifen is a good example of that because it was trailblazing in terms of getting approvals—first in adjuvant treatment
and then in DCIS [ductal carcinoma in situ], which is precancerous, and even to be used in place of mastectomy in women who
are at high risk of developing breast cancer. Those approvals came about the same time the patent expired, so they never got
any commercial value out of them. And that's the real problem that we have to change.
Nader Naeymi-Rad, senior vice president, brand management practice, Campbell Alliance
A Real Mouthful
CLINTON: There's another big shift happening within the oncology arena: oral therapies. How have they changed the marketplace?
LACAZE: At Bristol, we've done some of the research around the dynamics in the infusion centers. Some patients say going to the infusion
centers reminds them that they have cancer. They don't like it. When you talk with other patients, though, they actually find
that very therapeutic from the standpoint that they can talk to other people experiencing the same issues.
So when we ask patients, oral versus intravenous, they overwhelmingly say the oral agents. But in the near future, probably
in the midterm over the next decade or two, both IV and orals are going to play an incredibly important role in treating patients.
AYERS: The real issue is who pays for them—and right now, for many US patients, the oral anticancer drugs are on Tier III with a
very high co-pay. Medicare patients taking oral drugs go into the doughnut hole and have to pick up a significant amount of
costs, whereas if they get an IV drug, they don't have that issue.
It's really anomalous because oral treatments could cost less overall without the office visits for the IV administration.
Then when we go outside of the United States, we have the same type of issues about moving from a hospital budget to a pharmacy
or some other sort of primary care–type budget. And those budgets don't want to pay for oral drugs.
LACAZE: Three years ago, oral therapies weren't covered at all. So while this category isn't perfect, Medicare Part D at least makes
it available to many patients who couldn't even attain it three years ago.
SEELEY: We will have to see whether the reimbursement system evolves to where the pharmacy budget and the IV budget merge and the
trade-offs can be made between the full selection of therapy options—or whether they'll remain like they are now, in relatively
CLINTON: But for now, cancer patients on Medicare that use oral drugs hit the doughnut hole in March.
AYERS: That's an issue. I hope, going forward, Medicare would amend that so that for catastrophic care, patients weren't forced
into that situation. That's too much of the burden that cancer patients should have to cope with.
CLINTON: Has Medicare changed the way physicians prescribe therapies?
SEELEY: It significantly reduced the buffer between [therapy choice and] reimbursement. It has made some physicians more anxious about
the therapies they choose for particular patients—there is a risk that they might not get reimbursed for that particular therapy.
And I think that has some impact on the way patients are treated today versus prior to MMA.
LACAZE: Especially as it relates to off-label or non-compendium areas.