While cancer treatments are being developed at a rapid rate and offering hope to many patients, cancer has become the leading cost driver for funds. This combination poses a challenging problem (and opportunity) for fund leaders: How do we leverage the groundbreaking new innovations in cancer for our members while containing the increasing cost of treating (and at times curing) cancer?

STATS AND OBSERVATIONS:

• 40% of Americans will be diagnosed with cancer in their lifetime.[i]
• In 2022, cancer/oncology surpassed musculoskeletal conditions to become the #1 cost driver for health plans.[ii]
• Cancer deaths are down more than 33% since 1990 – much of that is due to new and emerging therapies.[iii] For example, new breakthrough therapies in lung cancer and advanced melanoma have dramatically improved outcomes in both diseases across the last 5 years.
• Breakthrough techniques are allowing some patients to avoid surgery all-together. A new study showed that immunotherapy alone cured 18 patients of early-stage rectal cancer with a specific mutation, a 100% success rate.[iv]
• The average cost of new cancer drugs is quickly approaching $300,000 a year[v], a 53% increase from 2017, and some treatments such as new cellular therapies can cost more than $500,000.[vi]
• New cancer detection technologies, such as GRAIL’s Galleri test, can detect 50+ types of cancer through a blood test, greatly improving our chances of catching cancers early.[vii]

IDEAS TO CONSIDER:

• With Bolton and our partners, do a deep dive into your cancer claims data (at no cost) to pinpoint potential opportunity areas. Gaining a deeper comprehension of cancer within the population can provide valuable insight into determining the most logical actions to include in your plan.
• Partnering with next-gen cancer screening blood tests (such as GRAIL) to catch numerous types of cancer at earlier stages when there is a greater chance for a cure (and lower cost to the plan).
• A focus on cancer-specific navigation programs that will lead every patient to fantastic centers for their specific diagnosis. New programs help members meet the experts that are well-equipped for their unique clinical situation and will help manage the cost of the plan.

If we can help, contact your Bolton representative, or email us at solutions@boltonusa.com.

[i] https://www.cancer.gov/about-cancer/understanding/statistics

[ii] https://www.businessgrouphealth.org/en/newsroom/news%20and%20press%20releases/press%20releases/2023%20lehcspds

[iii] https://www.pennmedicine.org/news/publications-and-special-projects/penn-medicine-magazine/spring-2023/why-new-cancer-treatment-discoveries-are-proliferating

[iv] https://www.mskcc.org/news/rectal-cancer-clinical-trial-msk-changed-everything-its-patients

[v] https://www.reuters.com/business/healthcare-pharmaceuticals/new-us-cancer-drug-prices-rise-53-five-years-report-2022-11-02/

[vi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566791/

[vii] https://grail.com/press-releases/grail-announces-final-results-from-the-pathfinder-multi-cancer-early-detection-screening-study-at-esmo-congress-2022/