Excerpts from Pricey Drugs Put Squeeze on Doctors,
by Marilyn Chase, The Wall Street Journal, July 8, 2008

… American doctors rarely used to let costs factor into their treatment decisions. But rising prices — some cancer drugs now cost more than $100,000 a year — are dramatically changing that ethos in the field of oncology. Money issues are now disrupting relationships with patients, causing doctors to go into debt and threatening to interfere with treatment options.

Unlike most physicians, who write patients prescriptions they can fill at a pharmacy, oncologists must buy many drugs upfront because they’re delivered intravenously in the office. As a result, doctors are on the hook until patients or insurers pay the bill. Reimbursement delays and denials are now more common as insurers clamp down on claims. Some patients can’t afford high co-payments.

… In February, after delays in payments from insurers, Dr. [Stephen] Hufford [a San Francisco oncologist] was working to pay off several hundred thousand dollars of past- due bills to his drug distributor. When he ordered $20,000 of chemotherapy for three patients he was to see the next day, he says the distributor refused to deliver the drugs unless he paid in advance and reduced his outstanding balance by another $20,000. He didn’t have $40,000 in his bank account.

… In a survey of 167 cancer doctors reported last year in the Journal of Clinical Oncology, 42% said they regularly raised the issue of costs when discussing treatment options with patients. …23% of oncologists said costs influence their treatment decisions, and 16% said they omit discussion of very expensive treatments when they know the cost will place great strain on patients’ resources.

… At Georgia Cancer Specialists, one of the largest private cancer practices in the Southeast with 29 offices, oncologist Bruce Feinberg says inadequate reimbursements — exacerbated by the cost of drugs — are starting to come out of doctors’ incomes. In addition, the practice has taken several steps to trim operations, including closing two unprofitable offices and adhering strictly to 10-minute time limits on regular follow-up office visits.