Last year Health Minister Aaron Motsoaledi said that if no drastic action against unaffordable cancer and tuberculosis drugs was taken, the country would be counting body bags like it was at war. Unfortunately, it doesn’t look like much has changed since he made the contentious statement because just last month the Competition Commission highlighted the exorbitant fees patients must pay in order to fight the battle against cancer.
In June the commission issued a statement saying it would initiate separate investigations against global pharmaceutical companies Roche, Pfizer and Aspen for suspected excessive overpricing of cancer medicines. For example, with Roche, the commission pointed out, a 12-month course of Herceptin in the private sector costs more than R500 000 and more if a higher dose is required. “As a result of exorbitant prices, most breast cancer patients in both the private and public sectors are unable to get treatment,” said the commission.
Herceptin is not the only expensive cancer treatment. According to an editorial by the SA Medical Journal, new-generation immunotherapy drugs such as Ipilimumab cost around R1 million, while immunotherapy for metastatic melanoma will set you back about R1 million.
The struggle by private and public institutions
In the private sector, the cost of cancer treatment is impacting on medical scheme premiums, making them unaffordable. “There is an increasing number of new cancer medicines that are extremely high cost, and Discovery Health is concerned by the impact of these high drug prices on the cost of claims, which drives premium increases over time, making it harder for members to afford their medical aid premiums,” says Dr Jonathan Broomberg, CEO of Discovery Health.
These increasing costs have resulted in most medical schemes being very conservative with their efforts in treating cancer. They do, after all, have to maintain the pool of funds to ensure that it covers all their beneficiaries.
“As a rule, experimental treatment is not covered by medical schemes. In exceptional circumstances, on a case-by-case basis, we do review selected motivations from treating doctors for specific named patients where there are no other treatment options available,” explains Broomberg.
Meanwhile the public healthcare sector is also squeezed by the cost of treating cancer. According to the SA Medical Journal editorial, this squeeze could preclude the sector from providing even the most cost effective treatment programmes. In addition, patients also suffer long treatment delays as there’s a shortage of oncologists as well as limited resources.
So, regardless of whether you can afford private medical care or rely on the state healthcare system, you may not get the latest treatment available. “In all health systems, whether public or private, funds are limited and therefore it is impossible to provide benefits for every treatment to everyone,” adds Heidi Kruger, an independent medical scheme expert.
This doesn’t mean you’ll be given no treatment for cancer. For state patients it means you’d be getting conventional treatment, such as chemotherapy. When it comes to medical aids they are obligated to treat you in most cases.
“According to the Medical Schemes Act, medical schemes must cover treatable cancers. These are listed in the prescribed minimum benefits,” points out Kruger.