Cancer is the second-leading cause of death, just behind heart disease. In 2018, it killed 9.6 million people globally. The same year, there were over 18 million new cases of cancer worldwide, and by 2040, that figure is expected to reach almost 30 million.
Although cancer is a global problem, treatment is hardly uniform across countries. Due to largely unregulated drug pricing in the US, cancer patients in the states typically pay drastically more for medication than patients living in other parts of the world.
In 2017, an international team of researchers published results comparing the prices of eight drugs for a variety of types of cancers for the US, the UK, India, China, South Africa, Israel, and Australia. To standardize, they compared the costs for the necessary amount of each drug typically prescribed to treat a person weighing about 180 lbs (82 kg) for four weeks. In all but one case, drugs cost more for patients living in the US than any other country.
These are retail prices, so don’t necessarily represent out-of-pocket expenses. The team did not account for health insurance, or some of the cost-cutting options (coupons, essentially) drug makers occasionally offer some patients. But the data still serve as an example of the consequences of having no limits on what drug makers can charge for their products. And whether or not a patient pays directly for a drug, the retail costs have to be paid for by someone, and expenses to insurance companies or the government end up trickling down to patients in some form eventually.
Another study from 2017 found that, in the US, cancer drugs tend to become more expensive the longer they’re on the market, which is the opposite of what you’d expect as newer options are made available. But, as other research published last year found, between 2006 and 2015, newer drugs were more expensive than older ones. These price hikes didn’t appear to correspond to improved treatment, either.
Drug pricing in general in the US is largely unregulated, and the issue has created common ground for Democrats and Republicans in an otherwise deeply partisan Congress. Last week, both the House and the Senate held separate drug-price hearings, during which lawmakers floated the idea of shortening the length of time pharmaceutical companies would have to exclusively produce medications.
On Jan. 31, president Trump proposed eliminating the rebates that pharmacy benefit managers receive when they purchase drugs intended to go to consumers who use Medicare or Medicaid. Pharmacy benefit managers are the brokers who buy and negotiate prices with drug companies for pharmacies and insurance companies; the rebates they had been getting for purchasing brand-name drugs meant that they could pay up to 30% less than retail price. Patients, however, are responsible for the whole cost of the drug, and even with insurance (or Medicare or Medicaid) may need to make co-pays.