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timately switched to Medicare, which covered her rst chemotherapy pro- tocol. Her health stabilized.11
Delaying effective therapeutics can easily lead to cancer disease progres- sion. Breast cancer patients with a treatment delay of three months or more had a 12 percent lower ve-year survival rate compared with breast cancer patients with a zero to three- month delay. A four-week delay in receiving adjuvant chemotherapy has been associated with a signi cant decrease in disease-free survival and overall survival in colorectal cancer patients.12
Other oncology patients are required
to “fail rst” on chemotherapies that carry FDA black box warnings, which indicate the most severe and serious type of side effects. Newer oncology therapeutics, developed to eliminate many of those serious and severe side effects, are not accessible to patients due to step therapy policies.
Ironically, due to the side effects of older chemotherapies, many patients seek emergency room services and/or are admitted to the hospital, which in turn adds to readmission rates and overall healthcare costs.
A large health insurer ran an ex- periment that allowed oncologists to prescribe as many cancer drugs as the
doctor thought appropriate, regard- less of cost, for their patients. Doctors prescribed more drugs, including the more expensive ones. Remarkably, total cost of care for those patients went down. The experiment showed that when patients receive effective therapeutics and use them appro- priately, overall healthcare costs are lowered due to reduced side effects, emergency room visits and hospital admissions.13
Challenging Policies
Multiple patient advocacy groups have issued statements against step therapy policies. For example, the
ONCOLOGY PATIENTS ARE REQUIRED
TO “FAIL FIRST” ON CHEMOTHERAPIES THAT CARRY FDA BLACK BOX WARNINGS, WHICH INDICATE THE MOST SEVERE AND SERIOUS TYPE OF SIDE EFFECTS.
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