Perspectives

An open conversation with a patient at this transition point of an MBC diagnosis should stress that, although the disease may be incurable, care can focus on control and hope as long as possible, with a balance for quality of life.
Breast cancer is not simply one disease, and the use of more effective therapies that target different tumor markers, such as the cyclin-dependent kinase (CDK)4/6 pathway in estrogen receptor–positive breast cancer, may actually reduce the total cost of care for patients/members and payers.

For patients with advanced breast cancer, prognosis remains especially suboptimal, primarily because of acquired pharmacologic resistance. Fortunately, several new drugs and drug combinations have recently become available.

Depending on the patient’s needs, the clinical pharmacist may also work with other staff members, such as financial counselors or social workers, to optimize patient care. Similarly, clinical pharmacists confer with specialty pharmacists to ensure that insurance issues are resolved so that the patient receives timely access to treatment.

It is exciting to see that patients with advanced breast cancer are able to receive additional treatment options, because a primary concern of patients with stage IV breast cancer is a lack of awareness of laboratory and clinical research targeted for those battling advanced disease.

Outside of initial clinical trials, few tools are available to assess the real-world impact of breast cancer on patients. In a research letter published in February 2017 in the Journal of the American Medical Association, the authors compared the impact of several new cancer drugs on progression-free survival (PFS) with their impact on the patient’s quality of life and annual cost.3

Ongoing patent litigation and the “patent dance” in general have been thorns in the side of biosimilar drug manufacturers and payers who are anticipating lower-cost alternatives to high-cost reference biologics.
In the past 5 years, there has been a large increase in the number of employers focused on effective ways to manage the rising cost of specialty drugs. At the same time, employers have been working hard to comply with the Affordable Care Act (ACA) and are cognizant of the expected excise tax.
With the 2015 extension of time offered to employers for Affordable Care Act (ACA) compliance, many employers are back to focusing their attention on cost management efforts.
After the passage of the Affordable Care Act (ACA) in 2010, market changes beyond those already in play began to emerge. Traditional roles, responsibilities, and authority of various healthcare stakeholders could now be tested or altered as a result of some sections of the ACA.
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