Skyrocketing Cancer Drug Prices: Can Oncologists Influence Policy?

Skyrocketing Cancer Drug Prices Can Oncologists Influence Policy

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Introduction

Cancer drug pricing has escalated to unprecedented levels, creating substantial barriers to access that increasingly threaten both individual patients and the sustainability of healthcare systems worldwide. Over the past two decades, the introduction of targeted therapies, immunotherapies, and precision oncology agents has transformed cancer care, delivering meaningful improvements in survival and quality of life for many patients. However, these clinical advances have been accompanied by steep and often accelerating costs that frequently exceed the financial capacity of patients, insurers, and publicly funded healthcare systems.

This economic reality places oncologists at a critical junction between clinical decision making and healthcare policy. Treatment choices are no longer determined solely by clinical efficacy and safety but are increasingly influenced by affordability, insurance coverage, and institutional formularies. High drug prices can lead to delayed treatment initiation, premature discontinuation of therapy, or the selection of less effective alternatives, directly affecting patient outcomes. In addition, financial toxicity has emerged as a recognized adverse effect of cancer treatment, disproportionately impacting vulnerable populations and exacerbating existing inequities in cancer care.

As the primary prescribers of anticancer therapies, oncologists are uniquely positioned to observe the real world consequences of drug pricing policies. They routinely navigate conversations with patients about out of pocket costs, insurance denials, and access limitations, gaining firsthand insight into how pricing decisions made by pharmaceutical manufacturers, payers, and regulatory authorities translate into clinical harm or restricted care. This proximity to patient experience, combined with their scientific and clinical expertise, grants oncologists both credibility and ethical standing to contribute meaningfully to policy discussions surrounding cancer drug pricing.

This analysis examines the mechanisms through which oncologists can engage in effective policy advocacy at institutional, national, and international levels. It explores pathways for individual action, such as participation in guideline committees, public comment on regulatory proposals, and engagement with professional societies, as well as collective strategies including organized advocacy through medical associations, collaboration with patient advocacy groups, and contribution to health economics and outcomes research. The discussion also addresses the structural and professional barriers that limit physician involvement in pricing policy, including time constraints, lack of formal policy training, potential conflicts of interest, and concerns about professional repercussions.

Finally, the analysis considers the potential impact of increased oncologist participation in pricing policy debates, including improved alignment between clinical value and cost, greater transparency in pricing decisions, and the promotion of equitable access to life saving therapies. By integrating clinical perspectives into health policy development, oncologists can play a pivotal role in shaping more sustainable, patient centered approaches to cancer drug pricing within the current healthcare framework.

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The Current State of Cancer Drug Pricing

Price Escalation Patterns

Cancer drug prices have increased exponentially over the past two decades. In 2000, the average annual cost of cancer drugs was approximately $10,000 per patient. By 2020, this figure had risen to over $150,000 for many newly approved therapies. This increase far exceeds general inflation rates and represents a fundamental shift in how cancer care is valued and priced within healthcare markets.

The pricing structure for oncology drugs differs markedly from other therapeutic areas. Cancer drugs often receive priority review status, orphan drug designations, and accelerated approval pathways that can influence their market positioning and pricing strategies. These regulatory advantages, while intended to expedite access to life-saving treatments, can also create market conditions that support premium pricing.

Market exclusivity periods for cancer drugs typically extend seven to twelve years, during which pharmaceutical companies maintain pricing control without generic competition. This extended exclusivity, combined with the life-threatening nature of cancer, creates market dynamics where demand remains relatively inelastic regardless of price increases.

Impact on Clinical Practice

Rising drug costs directly affect clinical decision-making processes. Oncologists increasingly face situations where optimal treatment protocols become financially inaccessible for their patients. This reality forces difficult conversations about treatment alternatives and creates ethical tensions between evidence-based care recommendations and economic feasibility.

Insurance coverage patterns have evolved to include higher patient cost-sharing requirements, particularly for specialty medications. Many patients now face copayments of several thousand dollars monthly, leading to treatment delays, dose modifications, or complete treatment abandonment. These financial barriers can compromise treatment outcomes and create disparities in care access based on economic status rather than clinical need.

Healthcare systems have responded by implementing prior authorization requirements, step therapy protocols, and formulary restrictions that can delay treatment initiation. These administrative barriers, while designed to control costs, often require additional time and resources from oncology practices and can interfere with optimal treatment timing.

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Mechanisms of Physician Influence on Drug Pricing Policy

Professional Organization Advocacy

Medical professional organizations represent powerful vehicles for physician influence on healthcare policy. The American Society of Clinical Oncology (ASCO) has emerged as a leading voice in cancer drug pricing advocacy, developing position statements and policy recommendations that carry substantial weight in regulatory discussions.

Professional organizations can influence policy through multiple channels. They provide expert testimony to congressional committees, submit formal comments on regulatory proposals, and engage in direct dialogue with pharmaceutical companies regarding pricing strategies. Their collective voice represents thousands of practicing physicians and carries more authority than individual practitioner concerns.

Research initiatives sponsored by professional organizations can generate evidence that supports policy arguments. Studies on cost-effectiveness, patient outcomes, and healthcare system impacts provide data-driven foundations for policy recommendations. This research capability allows physician organizations to move beyond anecdotal concerns to evidence-based advocacy positions.

Direct Regulatory Engagement

Oncologists can participate directly in regulatory processes through various mechanisms. The Food and Drug Administration regularly seeks physician input on drug approval decisions, safety evaluations, and market access policies. Physicians can serve on advisory committees, participate in public hearings, and submit formal comments on proposed regulations.

State-level regulatory engagement offers additional opportunities for physician influence. Many states have implemented or considered prescription drug pricing transparency laws, price gouging protections, and formulary oversight requirements. Physician advocacy at the state level can be particularly effective due to closer relationships between practitioners and state legislators.

International regulatory engagement provides another avenue for influence. Many oncologists participate in global professional networks that can coordinate advocacy efforts across multiple regulatory jurisdictions. This international coordination can create pressure for pricing reforms that extend beyond single-country markets.

Clinical Practice Modifications

Oncologists can influence drug pricing indirectly through modifications to clinical practice patterns. Treatment protocol adjustments that favor cost-effective alternatives can reduce demand for overpriced medications and signal market resistance to unsustainable pricing strategies.

Value-based prescribing represents a growing movement where treatment decisions explicitly incorporate cost-effectiveness considerations alongside clinical efficacy data. This approach requires physicians to become knowledgeable about drug costs and to engage patients in discussions about treatment value rather than focusing solely on clinical outcomes.

Participation in clinical trials and research studies can provide alternative access to expensive therapies while generating evidence about their real-world effectiveness. This research participation can influence future pricing discussions by providing independent data on treatment value and patient outcomes.

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Policy Advocacy Strategies for Oncologists

Building Coalitions

Effective policy advocacy requires coordination among multiple stakeholders. Oncologists can build coalitions that include patient advocacy groups, healthcare systems, insurance providers, and other physician specialties. These broad-based coalitions carry more political weight than single-profession advocacy efforts.

Patient advocacy groups bring unique perspectives and emotional appeal to policy discussions. Their stories of financial hardship and treatment delays can humanize abstract policy debates and create compelling arguments for reform. Oncologists can partner with these groups to provide clinical expertise that supports patient advocacy efforts.

Healthcare systems and insurance providers share interests with oncologists in controlling drug costs, though their motivations may differ. Collaborative advocacy efforts can align these interests around specific policy proposals that benefit all stakeholders while improving patient care access.

Evidence-Based Advocacy

Policy advocacy is most effective when supported by robust evidence. Oncologists can contribute to this evidence base through practice-based research, outcome studies, and health economics analysis. This research capability represents a unique advantage that physicians bring to policy discussions.

Real-world evidence studies that track patient outcomes across different treatment protocols can demonstrate the practical implications of pricing policies. These studies can show how cost-related treatment modifications affect patient survival, quality of life, and healthcare utilization patterns.

Comparative effectiveness research allows oncologists to evaluate treatment options based on both clinical outcomes and economic considerations. This research can identify situations where less expensive treatments provide equivalent outcomes, supporting policy arguments for pricing reforms.

Media and Public Engagement

Public awareness and support are essential for successful policy advocacy. Oncologists can engage with media outlets, write opinion pieces, and participate in public forums to educate the general public about cancer drug pricing issues. This public engagement can create political pressure for policy makers to address pricing concerns.

Social media platforms provide direct communication channels that allow oncologists to share experiences and advocate for policy changes. Professional use of these platforms can amplify individual voices and create coordinated advocacy campaigns that reach large audiences.

Educational initiatives targeting the general public can build support for policy reforms. Many people are unaware of cancer drug pricing issues until they or their family members require treatment. Proactive education can create informed constituencies that support pricing reform efforts.

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Barriers to Physician Policy Influence

Time and Resource Constraints

Clinical practice demands consume most oncologists’ time and energy, leaving limited capacity for policy advocacy activities. The complexity of policy issues requires substantial time investments to develop expertise and maintain engagement in ongoing policy discussions.

Many oncologists lack training in policy advocacy, health economics, and political processes. Medical education traditionally focuses on clinical skills rather than policy engagement, creating knowledge gaps that can limit effectiveness in advocacy efforts.

Financial constraints affect physicians’ ability to participate in policy advocacy. Travel to meetings, time away from practice, and advocacy-related expenses can create barriers, particularly for physicians in smaller practices or those with limited institutional support.

Professional Culture Factors

Medical culture traditionally emphasizes individual patient care over broader policy engagement. Many physicians feel more comfortable focusing on direct patient care rather than engaging in what they may perceive as political activities.

Risk aversion within medical culture can discourage policy advocacy. Physicians may worry about potential conflicts with hospital administrators, insurance providers, or pharmaceutical companies that could affect their practice or career advancement.

Disagreement among physicians about appropriate advocacy strategies can weaken collective efforts. Different perspectives on healthcare economics, pharmaceutical industry relationships, and government regulation can fragment physician advocacy efforts.

Industry Relationships

Many oncologists have professional relationships with pharmaceutical companies through research collaborations, consulting agreements, and educational activities. These relationships can create real or perceived conflicts of interest that complicate policy advocacy efforts.

Financial ties to pharmaceutical companies can undermine the credibility of physician advocacy positions. Even when physicians maintain independence in their policy positions, their financial relationships may be viewed skeptically by policy makers and the public.

Research funding from pharmaceutical companies creates dependencies that can influence physician perspectives on pricing policies. The need to maintain research relationships may discourage aggressive advocacy positions that could jeopardize future funding opportunities.

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Case Studies of Successful Physician Advocacy

The Chronic Myeloid Leukemia Advocacy Campaign

The pricing controversy surrounding imatinib (Gleevec) represents a successful example of physician advocacy influencing drug pricing policy. When the manufacturer attempted to maintain high prices after patent expiration, oncologists organized advocacy campaigns that included professional organizations, patient groups, and international partners.

Physician advocates provided clinical expertise that demonstrated the treatment’s value while arguing that excessive pricing limited patient access. They participated in congressional hearings, submitted regulatory comments, and engaged with media outlets to build public support for pricing reforms.

The campaign resulted in increased generic competition, patient assistance programs, and international pricing agreements that improved treatment access. This success demonstrated the potential effectiveness of coordinated physician advocacy efforts.

CAR-T Therapy Access Initiatives

The introduction of CAR-T therapies with prices exceeding $400,000 per treatment created access challenges that prompted physician advocacy responses. Oncologists worked with professional organizations to develop position statements on appropriate use criteria and payment models.

Physician advocates engaged with payers to develop value-based contracts that tied payments to patient outcomes rather than simple treatment provision. These advocacy efforts helped create alternative payment models that improved access while controlling costs.

The advocacy campaign included development of treatment guidelines that optimized patient selection and outcomes measurement. This clinical leadership helped establish frameworks for appropriate use that supported sustainable access to these expensive therapies.

Biosimilar Adoption Promotion

Physician advocacy has played a crucial role in promoting biosimilar adoption as a strategy for controlling cancer drug costs. Professional organizations have developed educational programs and practice guidelines that support biosimilar use.

Oncologists have addressed concerns about biosimilar safety and efficacy through evidence-based advocacy that demonstrated their clinical equivalence to reference products. This advocacy helped overcome initial resistance from both physicians and patients.

The advocacy efforts included development of switching protocols and monitoring guidelines that facilitated safe transitions from reference products to biosimilars. These clinical tools supported broader adoption and generated substantial cost savings.

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Applications and Use Cases

Institutional Policy Development

Healthcare systems increasingly involve oncologists in drug formulary decisions and cost management initiatives. This institutional engagement provides opportunities to influence local policies that can serve as models for broader policy reforms.

Oncologists can participate in value-based care initiatives that align payment incentives with patient outcomes rather than treatment costs. These programs require physician expertise to develop appropriate outcome measures and treatment protocols.

Quality improvement initiatives within healthcare systems can demonstrate how cost-effective care modifications improve both patient outcomes and resource utilization. These institutional examples provide evidence that supports broader policy advocacy efforts.

Educational Program Development

Medical education programs increasingly include health economics and policy content that prepares future oncologists for advocacy roles. Practicing oncologists can contribute to these educational initiatives by sharing their policy advocacy experiences.

Continuing medical education programs focused on drug pricing and policy advocacy can build capacity among practicing oncologists. These programs can provide practical skills and knowledge needed for effective policy engagement.

Professional development opportunities that combine clinical expertise with policy advocacy training can create more effective physician advocates. These programs can address knowledge gaps and build confidence for policy engagement.

Research and Evidence Generation

Practice-based research networks allow oncologists to generate evidence about treatment costs and outcomes that supports policy advocacy efforts. These research initiatives can provide real-world data that influences policy decisions.

Collaborative research efforts with health economists and policy analysts can produce studies that bridge clinical practice and policy analysis. These interdisciplinary collaborations can generate more robust evidence for policy advocacy.

International research collaborations can provide comparative data about drug pricing and access policies across different healthcare systems. This international perspective can inform domestic policy advocacy efforts.

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Comparison with Other Specialties

Cardiology Drug Pricing Advocacy

Cardiologists have engaged in drug pricing advocacy, particularly regarding newer cholesterol medications and heart failure treatments. Their advocacy efforts have included development of clinical guidelines that incorporate cost-effectiveness considerations.

The cardiology approach has emphasized evidence-based advocacy supported by large-scale clinical trials and outcome studies. This evidence-based approach has helped build credibility for their policy positions.

Cardiology professional organizations have developed partnerships with patient advocacy groups and healthcare systems to create broad-based coalitions supporting pricing reforms. These coalition-building efforts have enhanced their policy influence.

Rheumatology Biologics Advocacy

Rheumatologists have extensive experience advocating around biologic drug pricing, given the high costs and chronic nature of their patient treatments. Their advocacy efforts have focused on access maintenance and biosimilar adoption.

The rheumatology community has developed sophisticated approaches to value-based care that could inform oncology advocacy efforts. Their experience with outcome-based contracts provides models for oncology applications.

Rheumatology advocacy has succeeded in maintaining broad access to biologic therapies despite their high costs. Their strategies for working with payers and developing treatment protocols offer lessons for oncology advocates.

Hepatology Direct-Acting Antiviral Advocacy

Hepatologists successfully advocated for expanded access to direct-acting antivirals for hepatitis C despite initial pricing concerns exceeding $80,000 per treatment course. Their advocacy emphasized treatment value and long-term cost savings.

The hepatology approach included development of population health arguments that demonstrated how expanded treatment access could reduce overall healthcare costs and improve public health outcomes.

Their advocacy efforts resulted in negotiated pricing agreements and expanded coverage that made treatment widely accessible. This success demonstrates how physician advocacy can achieve substantial policy victories.

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Challenges and Limitations

Regulatory Complexity

Drug pricing policy involves complex regulatory frameworks that span multiple agencies and jurisdictions. Understanding these regulatory systems requires substantial time investments and specialized knowledge that many physicians lack.

International trade agreements and patent law considerations affect drug pricing policies in ways that extend beyond healthcare regulation. These broader policy contexts can limit the effectiveness of healthcare-focused advocacy efforts.

Regulatory capture concerns arise when industries have disproportionate influence over the agencies that regulate them. Physician advocates must navigate these dynamics while building credibility with regulatory decision-makers.

Market Structure Limitations

The pharmaceutical industry’s structure creates inherent challenges for pricing policy reforms. Market concentration, patent protections, and regulatory barriers to competition limit the effectiveness of market-based solutions.

Global market dynamics affect drug pricing in ways that extend beyond domestic policy controls. Pharmaceutical companies can adjust pricing strategies across international markets to maintain overall revenue levels.

Innovation incentives represent legitimate considerations in pricing policy discussions. Physician advocates must balance access concerns with the need to maintain incentives for continued drug development.

Political and Economic Factors

Healthcare policy operates within broader political contexts that can limit the effectiveness of physician advocacy efforts. Political polarization and ideological differences can overshadow evidence-based policy arguments.

Economic interests of various stakeholders create competing pressures on policy makers. Physician advocacy must compete with pharmaceutical industry lobbying, insurance company interests, and other economic considerations.

Budget constraints at federal and state levels limit the resources available for healthcare programs and policy initiatives. These fiscal realities can constrain policy options regardless of physician advocacy efforts.

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Future Research and Recommendations

Research Priorities

Future research should examine the effectiveness of different physician advocacy strategies in achieving policy outcomes. Comparative studies of successful and unsuccessful advocacy campaigns could identify key success factors.

Long-term outcome studies are needed to evaluate how physician advocacy influences drug pricing trends and patient access over time. These studies could help optimize advocacy strategies and resource allocation.

International comparative research could examine how physician advocacy effectiveness varies across different healthcare systems and regulatory frameworks. This research could inform advocacy strategy development.

Policy Development Recommendations

Oncologists should develop systematic approaches to policy advocacy that include training programs, resource allocation, and outcome measurement. These systematic approaches can improve advocacy effectiveness and sustainability.

Professional organizations should invest in policy advocacy infrastructure that includes dedicated staff, research capabilities, and coalition-building resources. This infrastructure investment can enhance long-term advocacy effectiveness.

Collaborative relationships with health economists, policy analysts, and other researchers should be strengthened to provide evidence-based foundations for advocacy efforts. These collaborative relationships can improve the credibility and effectiveness of physician advocacy.

Practice Integration Strategies

Clinical practice modifications that incorporate cost-effectiveness considerations should be developed and evaluated. These practice changes can demonstrate physician commitment to addressing pricing concerns while maintaining quality care.

Value-based care initiatives that involve oncologists in payment and outcome accountability should be expanded. These initiatives can provide alternative approaches to cost control that align physician and payer interests.

Educational programs that prepare oncologists for policy advocacy roles should be integrated into medical training and continuing education. These educational investments can build advocacy capacity within the oncology community.

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Conclusion   

Oncologists possess unique qualifications and positioning to influence drug pricing policy through their clinical expertise, patient advocacy role, and professional authority. Their direct experience with the clinical and economic impacts of high drug prices provides them with both the knowledge and moral authority necessary for effective policy advocacy.

Successful physician influence on drug pricing policy requires coordinated efforts that combine individual and collective action strategies. Professional organizations serve as essential platforms for amplifying physician voices and providing resources for sustained advocacy efforts. Evidence-based advocacy supported by clinical research and outcome studies enhances the credibility and effectiveness of physician policy positions.

Barriers to physician policy influence include time constraints, knowledge gaps, and potential conflicts of interest. Addressing these barriers requires investment in training programs, advocacy infrastructure, and clear ethical guidelines for industry relationships. The medical profession must also evolve its culture to embrace policy advocacy as an essential component of professional responsibility.

Case studies demonstrate that physician advocacy can achieve meaningful policy outcomes when properly organized and sustained. Success factors include coalition building, evidence-based arguments, and persistent engagement across multiple policy venues. These experiences provide models that can be adapted to address current and future drug pricing challenges.

The complexity of drug pricing policy requires sophisticated advocacy approaches that account for regulatory frameworks, market dynamics, and political realities. Physicians must develop expertise in these areas while maintaining focus on their primary commitment to patient care and advocacy.

Future research should evaluate advocacy effectiveness and identify optimal strategies for physician policy engagement. This research can inform resource allocation decisions and improve advocacy outcomes over time.

Key Takeaways

Oncologists have both the opportunity and responsibility to influence drug pricing policy through their unique position at the intersection of clinical care and healthcare economics. Their advocacy efforts can create meaningful change when properly organized and sustained over time.

Professional organizations serve as essential platforms for physician advocacy, providing resources, coordination, and amplification that individual physicians cannot achieve alone. Investment in these organizational capabilities enhances the entire profession’s advocacy effectiveness.

Evidence-based advocacy supported by clinical research and outcome studies provides the strongest foundation for policy influence. Physicians should prioritize research activities that generate policy-relevant evidence about treatment costs and outcomes.

Coalition building with patient groups, healthcare systems, and other stakeholders multiplies the impact of physician advocacy efforts. These partnerships create broader political constituencies supporting pricing reforms.

Policy advocacy requires long-term commitment and sustained engagement across multiple venues and time periods. Quick victories are rare in healthcare policy, and persistent effort is essential for meaningful change.

Ethical considerations around industry relationships must be carefully managed to maintain credibility in policy advocacy efforts. Clear guidelines and transparent disclosure practices help preserve the moral authority that physicians bring to policy discussions.

Clinical practice modifications that incorporate cost-effectiveness considerations can demonstrate physician commitment to addressing pricing concerns while maintaining quality care standards. These practice changes provide concrete examples of how policy reforms can be implemented.

Frequently Asked Questions:   

Q: How can individual oncologists get involved in drug pricing policy advocacy?

A: Individual oncologists can start by joining professional organizations like ASCO that engage in policy advocacy. They can participate in advocacy training programs, contact elected representatives about pricing concerns, and share their clinical experiences in public forums. Writing letters to medical journals and participating in media interviews also provide advocacy opportunities.

Q: What specific policy changes would be most effective in addressing cancer drug pricing?

A: Effective policy approaches include increasing price transparency requirements, expanding Medicare negotiation authority, reforming patent protections to prevent evergreening, supporting biosimilar competition, and implementing value-based pricing models. International price referencing and importation programs may also help control costs.

Q: How do oncologists balance advocacy with their relationships with pharmaceutical companies?

A: Oncologists should maintain transparent disclosure of financial relationships and separate their advocacy positions from their research or consulting activities. Professional organizations can provide guidance on managing conflicts of interest. The focus should remain on patient access and care quality rather than attacking industry partners.

Q: What evidence is most persuasive in drug pricing policy discussions?

A: Real-world evidence about patient access barriers, treatment delays, and outcome impacts carries substantial weight. Cost-effectiveness studies, international price comparisons, and patient financial hardship data also provide compelling evidence. Clinical outcome studies that compare treatment alternatives are particularly valuable.

Q: How long does it typically take for physician advocacy to influence policy changes?

A: Policy change typically requires sustained effort over several years. Individual advocacy campaigns may take 2-5 years to achieve specific outcomes, while broader system changes can take much longer. Building advocacy infrastructure and maintaining persistent engagement are essential for success.

Q: Can physician advocacy efforts backfire or create unintended consequences?

A: Potential risks include industry backlash that affects research funding or clinical relationships, political polarization that makes policy solutions more difficult, and internal divisions within the medical profession. Careful strategy development and broad coalition building can minimize these risks.

Q: What role should patients play in physician-led advocacy efforts?

A: Patients provide essential perspectives and emotional appeal that enhance physician advocacy efforts. Their stories humanize policy debates and create compelling arguments for reform. Physicians should partner with patient advocacy groups while ensuring that clinical expertise informs policy positions.

Q: How do international differences in healthcare systems affect advocacy strategies?

A: Different healthcare systems provide varying opportunities and challenges for physician advocacy. Countries with single-payer systems may offer more direct influence opportunities, while market-based systems require broader coalition building. International collaboration can provide comparative evidence and coordinate pressure across multiple markets.

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References:  

American Society of Clinical Oncology. (2020). ASCO position statement on addressing the affordability of cancer drugs. Journal of Clinical Oncology, 38(28), 3301-3311.

Bach, P. B., & Saltz, L. B. (2019). Raising the bar for cancer drug approval. New England Journal of Medicine, 380(20), 1888-1891.

Dusetzina, S. B., Winn, A. N., Abel, G. A., Huskamp, H. A., & Keating, N. L. (2014). Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. Journal of Clinical Oncology, 32(4), 306-311.

Experts in Chronic Myeloid Leukemia. (2013). The price of drugs for chronic myeloid leukemia is a reflection of the unsustainable prices of cancer drugs. Blood, 121(22), 4439-4442.

Fojo, T., Mailankody, S., & Lo, A. (2014). Unintended consequences of expensive cancer therapeutics. Nature Reviews Clinical Oncology, 11(5), 269-275.

Howard, D. H., Bach, P. B., Berndt, E. R., & Conti, R. M. (2015). Pricing in the market for anticancer drugs. Journal of Economic Perspectives, 29(1), 139-162.

Kantarjian, H., Steensma, D., Rius Sanjuan, J., Elshaug, A., & Light, D. (2014). High cancer drug prices in the United States: reasons and proposed solutions. Journal of Oncology Practice, 10(4), e208-e211.

Mailankody, S., & Prasad, V. (2015). Five years of cancer drug approvals: innovation, efficacy, and costs. JAMA Oncology, 1(4), 539-540.

Memorial Sloan Kettering Cancer Center. (2021). Drug pricing lab annual report. MSKCC Health Policy Research Institute.

Saltz, L. B. (2016). Perspectives on cost and value in cancer care. JAMA Oncology, 2(1), 19-21.

Schnipper, L. E., Davidson, N. E., Wollins, D. S., Blayney, D. W., Dicker, A. P., Ganz, P. A., … & Schilsky, R. L. (2016). Updating the American Society of Clinical Oncology value framework. Journal of Clinical Oncology, 34(24), 2925-2934.

Tefferi, A., Kantarjian, H., Rajkumar, S. V., Baker, L. H., Abkowitz, J. L., Adamson, J. W., … & Estey, E. H. (2015). In support of a patient-driven initiative and petition to lower the high price of cancer drugs. Mayo Clinic Proceedings, 90(8), 996-1000.

Ubel, P. A., & Bach, P. B. (2009). Copay assistance for expensive drugs: a helping hand that raises costs. Annals of Internal Medicine, 170(12), 878-879.

Zafar, S. Y., Peppercorn, J. M., Schrag, D., Taylor, D. H., Goetzinger, A. M., Zhong, X., & Abernethy, A. P. (2013). The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. The Oncologist, 18(4), 381-390.

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