Rochester, Minnesota - A group of 118 of the nation's leading cancer experts have drafted a prescription for reducing the high cost of cancer drugs and voiced support for a patient-based grassroots movement demanding action on the issue. Their recommendations and support are outlined in a commentary, co-authored by the group, in the journal Mayo Clinic Proceedings.

"High cancer drug prices are affecting the care of patients with cancer and our health care system," says lead author Ayalew Tefferi, M.D., a hematologist at Mayo Clinic. "The average gross household income in the U.S. is about $52,000 per year. For an insured patient with cancer who needs a drug that costs $120,000 per year, the out-of-pocket expenses could be as much as $25,000 to $30,000 – more than half their average household income."

The group cites a 2015 study by D.H. Howard and colleagues et al, published in the Journal of Economic Perspectives, which found that cancer drug prices have risen by an average of $8,500 per year over the past 15 years.

"When you consider that cancer will affect 1 in 3 individuals over their lifetime, and [with] recent trends in insurance coverage [that] put a heavy financial burden on patients with out-of-pocket expenses, you quickly see that the situation is not sustainable," Dr. Tefferi, says. "It's time for patients and their physicians to call for change."

The group says these actions would improve the situation and allow market forces to work better.

• Create a post-U.S. Food and Drug Administration drug approval review mechanism to propose a fair price for new treatments that is based on the value to patients and heath care
• Allow Medicare to negotiate drug prices
• Allow the Patient Centered Outcomes Research Institute, created through the Affordable Care Act, to evaluate the benefits of new treatments and similar organizations to include drug prices in their assessments of the treatment value
• Allow importation of cancer drugs across borders for personal use (For example, prices in Canada are about half of prices in the U.S.)
• Pass legislation to prevent drug companies from delaying access to generic drugs (pay for delay)
• Reform the patent system to make it more difficult to prolong product exclusivity unnecessarily (patent “evergreening”)
• Encourage organizations that represent cancer specialists and patients (e.g., American Society of Clinical Oncology, American Society of Hematology, American Association for Cancer Research, American Cancer Society, National Comprehensive Cancer Network to consider the overall value of drugs and treatments in formulating treatment guidelines

The group also supports the patient-based, grass-roots movement on change.org that advocates against high cancer drug prices with the goal of drawing the attention of pharmaceutical companies and elected representatives to this issue. The authors write, "with proper support of these grass-roots efforts and proper use of that support downstream, it should be possible to focus the attention of pharmaceutical companies on this problem and to encourage our elected representatives to more effectively advocate for the interests of their most important constituents among the stakeholders in cancer – American cancer patients."

Co-authors include:

• Vincent Rajkumar, M.D., Mayo Clinic, Rochester
• Morie Gertz, M.D., Mayo Clinic, Rochester
• Robert Kyle, M.D., Mayo Clinic, Rochester
• Hagop Kantarjian, M.D., University of Texas MD Anderson Cancer Center, Houston
• James Allison, University of Texas MD Anderson Cancer Center, Houston
• Robert Bast Jr., University of Texas MD Anderson Cancer Center, Houston
• Jorge Cortes, M.D., University of Texas MD Anderson Cancer Center, Houston
• Isaiah Fidler, D.V.M., Ph.D., University of Texas MD Anderson Cancer Center, Houston
• Emil Freireich, M.D., University of Texas MD Anderson Cancer Center, Houston
• Jordan Gutterman, University of Texas MD Anderson Cancer Center, Houston
• Waun Ki Hong, University of Texas MD Anderson Cancer Center, Houston
• Gabriel Hortobagyi, M.D., University of Texas MD Anderson Cancer Center, Houston
• John Mendelsohn, M.D., University of Texas MD Anderson Cancer Center, Houston
• Louise Strong, M.D., University of Texas MD Anderson Cancer Center, Houston
• Naoto Ueno, M.D., Ph.D., University of Texas MD Anderson Cancer Center, Houston
• Charles LeMaistre, M.D., University of Texas MD Anderson Cancer Center, Houston
• Lawrence Baker, D.O., University of Michigan, Ann Arbor, Michigan
• Theodore Lawrence, M.D., Ph.D., University of Michigan, Ann Arbor
• Jan Abkowitz, M.D., University of Washington Medical School, Seattle
• Joachim Deeg, M.D., University of Washington Medical School, Seattle
• Elihu Estey, M.D., University of Washington Medical School, Seattle
• Gary Lyman, M.D., M.P.H., University of Washington Medical School, Seattle
• John Adamson, M.D., University of California, San Diego School of Medicine, La Jolla, California
• Ranjana Hira Advani, M.D., Stanford University School of Medicine, Stanford, California
• Steven Coutre, Stanford University School of Medicine, Stanford

• Peter Greenberg, M.D., Stanford University School of Medicine, Stanford
• Michael Link, M.D., Stanford University School of Medicine, Stanford
• Saul Rosenberg, Stanford University School of Medicine, Stanford
• Karen Antman, M.D., Boston University School of Medicine, Boston
• John Bennett, M.D., University of Rochester Medical Center, Rochester, New York
• Edward Benz Jr., M.D., Dana-Farber Cancer Institute and Harvard Medical School, Boston
• George Peter Canellos, M.D., Dana-Farber Cancer Institute and Harvard Medical School, Boston
• George Daley, M.D., Ph.D., Dana-Farber Cancer Institute and Harvard Medical School, Boston
• Daniel DeAngelo, Dana-Farber Cancer Institute and Harvard Medical School, Boston
• Charles Fuchs, M.D., M.P.H., Dana-Farber Cancer Institute and Harvard Medical School, Boston
• Robert Handin, M.D., Dana-Farber Cancer Institute and Harvard Medical School, Boston
• Philip Kantoff, M.D., Dana-Farber Cancer Institute and Harvard Medical School, Boston
• David Steensma, M.D., Dana-Farber Cancer Institute and Harvard Medical School, Boston
• Richard Stone, Dana-Farber Cancer Institute and Harvard Medical School, Boston
• Eric Winer, M.D., Dana-Farber Cancer Institute and Harvard Medical School, Boston
• Nancy Berliner, M.D., Brigham and Women’s Hospital, Boston
• Robert Handin, M.D., Brigham and Women’s Hospital, Boston
• Joseph Bertino, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
• Ravi Bhatia, M.D., University of Alabama at Birmingham, Birmingham, Alabama
• Smita Bhatia, M.D., University of Alabama at Birmingham, Birmingham
• Harry Erba, M.D., Ph.D., University of Alabama at Birmingham, Birmingham
• Deepa Bhojwani, M.D., Children’s Hospital Los Angeles, Los Angeles
• Charles Blanke, M.D., Oregon Health & Science University, Portland, Oregon
• Clara Bloomfield, M.D., The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
• John Byrd, M.D., The Ohio State University Comprehensive Cancer Center, Columbus
• Raphael Pollock, M.D., Ph.D., The Ohio State University Comprehensive Cancer Center, Columbus
• Linda Bosserman, M.D.
• Stephen Forman, M.D., City of Hope Medical Foundation, Duarte, California
• Hal Broxmeyer, Ph.D., Indiana University School of Medicine, Indianapolis
• Lawrence Einhorn, M.D., Indiana University School of Medicine, Indianapolis
• Fernando Cabanillas, M.D., Auxilio Cancer Center, Hato Rey, Puerto Rico
• Bruce Chabner, M.D., Massachusetts General Hospital, Boston
• Gerardo Colon-Otero, M.D., Massachusetts General Hospital, Boston
• Asher Chanan-Khan, M.D., Mayo Clinic, Jacksonville, Florida
• James Foran, Mayo Clinic, Jacksonville, Florida
• Bruce Cheson, M.D., Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C.
• Bayard Clarkson, M.D., Memorial Sloan Kettering Cancer Center, New York City
• Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York City
• Clifford Hudis, M.D., Memorial Sloan Kettering Cancer Center, New York City
• Ross Levine, M.D., Memorial Sloan Kettering Cancer Center, New York City
• Martin Tallman, Memorial Sloan Kettering Cancer Center, New York City
• Anas Younes, M.D., Memorial Sloan Kettering Cancer Center, New York City
• Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York City
• Susan L. Cohn, M.D., University of Chicago, Chicago
• Harvey Golomb, M.D., University of Chicago, Chicago
• Samuel Hellman, M.D., University of Chicago, Chicago
• Richard A. Larson, M.D., University of Chicago, Chicago
• Wendy Stock, M.D., University of Chicago, Chicago
• Massimo Cristofanilli, M.D., Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia
• Walter Curran Jr., M.D., Winship Cancer Institute of Emory University, Atlanta
• Fadlo Khuri, M.D., Winship Cancer Institute of Emory University, Atlanta
• Sagar Lonial, M.D., Winship Cancer Institute of Emory University, Atlanta
• George Daley, M.D., Ph.D., Boston Children’s Hospital, Boston
• Joachim Deeg, M.D., Fred Hutchinson Cancer Research Center, Seattle
• Gary Lyman, M.D., M.P.H., Fred Hutchinson Cancer Research Center, Seattle
• Oliver Press, M.D., Ph.D., Fred Hutchinson Cancer Research Center, Seattle
• Jerald Radich, M.D., Fred Hutchinson Cancer Research Center, Seattle
• Brenda Sandmaier, Fred Hutchinson Cancer Research Center, Seattle
• Rainer Stone, Fred Hutchinson Cancer Research Center, Seattle
• Francisco Esteva, M.D., Ph.D., New York University Langone Medical Center, New York City

• James George, M.D., University of Oklahoma Health Sciences Center, Oklahoma City

• Paulo Marcelo Hoff, M.D., Universidade de Sao Paulo, Sao Paulo
• Ronald Hoffman, Icahn School of Medicine at Mount Sinai, New York City
• Mary Horowitz, M.D., M.S., Medical College of Wisconsin, Milwaukee
• Jean Pierre Issa, M.D., Temple University, Philadelphia
• Bruce Evan Johnson, M.D., Lowe Center for Thoracic Oncology, Boston
• Kenneth Kaushansky, M.D., Stony Brook University, Stony Brook, New York
• David Khayat, M.D., Ph.D., Pitié-Salpêtrière Hospital, Paris
• Thomas Kipps, M.D., Ph.D.
• Scott Lippman, M.D., University of California, San Diego Moores Cancer Center, La Jolla
• Margaret Kripke, Cancer Prevention and Research Institute of Texas, Austin, Texas

• Maurie Markman, M.D., Cancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia
• Neal Neropol, M.D., University Hospitals Case Medical Center and Case Western Reserve University, Cleveland
• Yoav Messinger, M.D., Children’s Hospitals and Clinics of Minnesota
• Therese Mulvey, M.D., Southcoast Centers for Cancer Care, Fairhaven, Massachusetts
• Susan O’Brien, M.D.
• Richard Van Etten, M.D., Ph.D., University of California, Irvine, California
• Roman Perez-Soler, Albert Einstein College of Medicine, New York City
• Josef Prchal, M.D., University of Utah, Salt Lake City
• Kanti Rai, North Shore-LIJ Cancer Institute, New York
• Jacob Rowe, Northwestern University Feinberg School of Medicine, Chicago
• Hope Rugo, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco
• Carolyn Runowicz, M.D., Florida International University Herbert Wertheim College of Medicine, Miami
• Alan Saven, M.D., Scripps Clinic Medical Group, La Jolla
• Richard Silver, M.D., Scripps Clinic Medical Group, La Jolla
• Andrew Schafer, M.D., Weill Cornell Medical College, New York City
• Charles Schiffer, Barbara Ann Karmanos Cancer Institute, Detroit
• Mikkael Sekeres, M.D., M.S., Cleveland Clinic, Cleveland
• Lillian Siu, M.D., Princess Margaret Cancer Centre, University Health Network, Toronto
• Marc Stewart, M.D., Seattle Cancer Care Alliance, Seattle
• Michael Thompson, M.D., Ph.D., Aurora Research Institute, Aurora Health Care, Milwaukee
• Julie Vose, M.D., M.B.A., University of Nebraska Medical Center, Omaha, Nebraska
• Peter Wiernik, M.D., Cancer Research Foundation, New York City

About Mayo Clinic Proceedings

Mayo Clinic Proceedings is a monthly peer-reviewed medical journal that publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Proceedings is sponsored by the Mayo Foundation for Medical Education and Research as part of its commitment to physician education. It publishes submissions from authors worldwide. The journal has been published for more than 80 years and has a circulation of 130,000. Articles are available at mayoclinicproceedings.org.