Level of Cost Sharing Faced by Patients with Cancer

Michael Kolodziej, MD, FACP

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The system by which healthcare is paid for in general clearly impacts how healthcare is obviously paid for in cancer. The vast majority of Americans get health insurance through employer?sponsored health insurance plans, and then Medicare is another big payer.

Over time, and especially now, there’s a lot of discussion about passing some of these price increases, cost increases to the patient. I think that’s really a challenge. It’s a challenge for patients. It’s a challenge for the plan.

We do not want patients to make bad decisions because of cost. We do not want to promote nonadherence with oral drugs, for example, because of cost. Yet, we would like patients to feel that they have some skin in the game, that their decisions are not cost?insensitive. There’s a very fine line here. Because of the cost of cancer therapy, I think we have to be really careful about how far this goes.

We should also never forget that the maximum out?of?pocket cost, which has been defined by the ACA, may not seem like a lot of money if you’re a doctor or a lawyer, but for the average American family, it’s a heck of a lot of money. I think we better not forget that. How we ask patients to participate in a value?driven fashion, that’s going to be a real trick.