The Rising Cost of Cancer Care: Beyond Drug Prices
The financial burden of cancer treatment, often termed “financial toxicity,” is a growing concern for patients and healthcare systems alike. While high prescription drug prices are a significant contributor, recent efforts to negotiate lower drug costs represent only one piece of the puzzle. A critical, often overlooked aspect is the potential for optimizing drug dosages to reduce both toxicity and spending, benefiting both patients and taxpayers.
Understanding Financial Toxicity
Financial toxicity describes the problems patients experience related to the cost of medical care. Studies display individuals with cancer are more likely to face financial hardship than those without the disease 1. This can stem from out-of-pocket costs like copayments, deductibles, and coinsurance, impacting a patient’s ability to function and pay bills. Cancer survivors often report higher out-of-pocket spending than those who have not had cancer, with some spending over 20% of their annual income on medical care 1.
Medicare Drug Price Negotiation Program: A Step Forward
In 2022, Congress passed a law allowing the Centers for Medicare & Medicaid Services (CMS) to negotiate maximum prices for certain brand-name drugs, particularly those with high Medicare spending. In the first two rounds of the Medicare Drug Price Negotiation Program (MDPNP), CMS secured discounted prices for 25 drugs, five of which are used to treat cancer. These negotiations resulted in an average discount of 47% (ranging from 38% to 60%) compared to pre-negotiation Wholesale Acquisition Costs (WAC), leading to estimated annual savings of $5.5 billion.
Recently, four additional oncology drugs – Erleada, Kisqali, Lenvima, and Verzenio – were added to the list of drugs subject to negotiation. If CMS achieves similar savings as before, an additional $2.8 billion in annual savings is projected.
Beyond Price Negotiation: Addressing Excessive Dosing
While price negotiation is crucial, CMS has another avenue to lower drug spending: ensuring that prescribed dosages are “reasonable and necessary.” Federal law requires CMS to cover items and services that are both reasonable and necessary, and to cover all antineoplastic (anticancer) drugs through Medicare Part D. However, current practice often involves administering drugs at the maximum tolerated dose (MTD), a practice rooted in the belief that “more is better.”
The Food and Drug Administration (FDA) approves anticancer drugs based on safety and efficacy, often at the MTD, which frequently causes significant side effects. However, for many drugs, lower doses can achieve the same therapeutic benefit with fewer side effects, and at a lower cost.
The Case for Optimized Dosing
The Optimal Cancer Care Alliance advocates for ensuring patients receive optimal doses of oncology drugs, recognizing that manufacturer-recommended and FDA-approved dosages often exceed what is truly necessary. Reducing excessive dosing can improve a patient’s quality of life by minimizing side effects, potentially preventing treatment discontinuation due to unacceptable toxicity, and lowering overall healthcare costs.
Recent research supports this approach. A study on Kisqali, approved at a dose of 600 mg daily, demonstrated that a lower dose of 400 mg yielded virtually identical survival and progression-free survival rates with reduced toxicity. Despite this finding, the FDA maintained the 600 mg dose as the initial recommendation, focusing on tumor size changes as the primary endpoint.
However, CMS could choose to cover only the lower dose, potentially saving one-third of the total cost on top of savings from price negotiation. A compendium of alternative dosage strategies for 90 patent-protected oral oncology drugs suggests potential median cost savings of 50% (ranging from 33% to 75%) for five of the nine drugs included in the MDPNP 2.
Looking Ahead
Addressing the rising cost of cancer care requires a multifaceted approach. Policymakers, payers, prescribers, and patients must recognize that the FDA-approved dose may not always be optimal. Lower dosages, supported by clinical data, can improve patient quality of life and reduce costs. A meeting, “Novel Solutions to Address the Rising Cost of Oncology Drugs: Targeting the Demand Side,” was convened on March 4-5 at Georgetown Law to further discuss these strategies.
Given the unsustainable increases in healthcare costs, exploring opportunities to reduce spending beyond price negotiations – including addressing excessive prescribing of toxic, expensive oncology drugs – is critical for both patients and taxpayers.
References
- National Cancer Institute. Financial Toxicity (Financial Distress) and Cancer Treatment (PDQ®)–Patient Version. https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-pdq. Accessed March 3, 2026.
- Villalona, S., Castillo, B.S., Chavez Perez, C.C., Ferreira, A., Nivar, I., & Cisneros, J. (2024). Interventions to Mitigate Financial Toxicity in Adult Patients with Cancer in the United States: A Scoping Review. Current Oncology, 31(2), 918–932. https://pmc.ncbi.nlm.nih.gov/articles/PMC10888212/. Accessed March 3, 2026.