This cancer doctor is leading the attack on astronomical drug prices

As Saltz sees it, all patients should be afforded access to effective treatments, even if a minority is able to spend extra on an even higher standard of care. “Somehow as a society, we’ve got to get everybody on the airplane—but that means getting everybody on coach, but that doesn’t mean some people won’t get on first class,” he said in the interview. In the United Kingdom and Canada, he noted, the governments ensure health care systems provide basic coverage for all citizens while wealthier patients pay for additonal care.

Saltz became interested in drug pricing in 2004, when a new drug for colon cancer, Erbitux, came out priced at more than $100,000 a year. Now such prices have become routine for new cancer drugs. An analysis by his colleagues at Memorial Sloan Kettering found that about half of new cancer drugs approved since 2010 cost $10,000 a month or more. Another study found that prices for cancer drugs are rising faster than the survival benefits, according to results published in the Journal of Economic Perspectives.

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Part of the problem, according to Saltz, is that U.S. government agencies are barred from considering price when evaluating new treatments. The Food and Drug Administration considers only safety and efficacy of drugs, while Medicare is prohibited from negotiating with drugmakers over price. European governments, by contrast, routinely negotiate prices.

That has left drug companies in the driver’s seat over prices in the U.S.—and Saltz believes the companies have been adept at deflecting the public conversation: “‘Let’s see the science. Let’s stick to the science,’ is something I was hearing from drug reps for a decade. It’s a way of killing the conversation.”

“As a doctor, I’m excited to see drugs that are really, truly working,” Saltz said. “And as one who is concerned about making sure we can make health care available to everyone, I’m really concerned that these drugs cost too much.”

Some drug company executives agree that it’s time to talk more seriously about how much the new cancer drugs are worth. “We have set up a system in the U.S. that deliberately blocks that kind of conversation, and we need a place to have it,” says Roger Perlmutter, head of research and development at Merck. “The question of what represents appropriate value is generally something that society has struggled with for a long time.”

Briggs Morrison, chief medical officer at AstraZeneca, says his company may be able to offer discounts for combinations of its own drugs if they work in combination, in contrast with cancer drug cocktails that mix products from different companies. “We think there is potential advantage to be able to go to a payer and say, ‘We have all three drugs that you need, and we’ll negotiate a price that you need for all three together,’” he says. “You could sell it at a discount to everybody else who’s charging for the two.”

Anthem (NYSE:ANTM) has implemented a program that incentivizes oncologists to use the most effective—and most cost-effective—drug by offering a bonus to doctors who put patients on the drugs the insurer deems to fit that criteria. Anthem estimates drug spending represents about a third of the cost of cancer care for the insurer, Jennifer Malin, Anthem’s medical director for oncology, said in an interview at the American Society of Clinical Oncology meeting. As for the newest cancer drugs coming to market, Malin said Anthem will look at the effectiveness and side-effect profile when making coverage decisions.