Opioid Epidemic, 340B Drug Discount Program Substantially Impact Patients, Community Oncology Practices


Debra Patt, MD, MPH, MBA, vice president, Texas Oncology, spoke at the Community Oncology Alliance (COA) Conference (April 12-13, 2018; National Harbor, MD) about the major issues affecting patients with cancer and community practices in the United States.

Dr Patt began the presentation by noting the policy trends that will impact cancer care; trends in provider shortages, opioid addiction, the aging population, drug payment reform, 340B, molecular phenotyping, and health care distribution were listed.

The United States annual cancer incidence is expected to reach 2.2 million per year by 2030, and while the majority of care is provided in the outpatient setting, the burden of care is on the patient and their caregivers.

Dr Patt acknowledged the growing issue of opioid addiction and went as far as to say that it is one of the House’s largest focuses. The growing trend of increased opioid prescription for cancer-related pain management has resulted in higher rates of addiction, she said.

The conversation then was directed toward the aging population in the United States. As the older population continues to grow and live longer, more cancer diagnoses are expected, which will mean significantly higher Medicare spending. By the year 2030, it is estimated that there will be over 80 million Medicare beneficiaries.

“At the moment, we are ripe for Medicare payment reform,” she said.

Dr Patt continued with a discussion of how the current cost of cancer care is unsustainable. To support this point, she pointed to precision therapies as particularly expensive, specific cases were a single cancer drug can cost up to $300,000 per year, and the prediction that expenditures for oncology care are projected to rise to $157 billion by 2020.

Dr Patt further echoed a trend that has been alluded to throughout the conference – the 340B drug discount program has led site of care trends to increase in the hospital outpatient setting and decrease in the community setting. From 2004 through 2014, 6-month episode total drugs costs have been doubled in the hospital outpatient setting compared to the physician office setting.


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In her concluding remarks, Dr Patt referenced an impending development in drug pricing reform: “Drug pricing innovation will be released in the next several months in the form of executive order and legislation,” she commented.

To wrap up her presentation, Dr Patt asserted that programs like 340B require reform, because when they grow without oversight they consolidate cancer care to a higher cost site of service, raise drug prices, and diminish community access to cancer care.—Zachary Bessette