每年48萬美元的藥丸反映癌症藥物價格的新常態（2/2）

Recently The New York Times reported the following:

A $480,000-a-Year Pill Reflects a New Normal for Cancer Drugs (2/2)

Rasonque, the new pancreatic cancer treatment from Revolution Medicines, illustrates the huge inflation in cancer drug prices over the past two decades.

The NYT - By Rebecca Robbins (Rebecca Robbins is a Times reporter covering the pharmaceutical industry. She has been reporting on health and medicine since 2015.)

Aug. 31, 2026, 5:03 a.m. ET

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A drug’s sticker price is not the real price paid by patients or their insurers — it’s just the starting point for negotiations that lower the final price for the employer or the government. But while that dynamic sharply reduces the true prices of diabetes and autoimmune drugs, the final price for cancer drugs is typically only slightly lower than the sticker price.

Cancer drugmakers and their defenders say the prices reflect a boom in innovation that has transformed deadly diseases into chronic ones and even produced cures.

And particularly in the case of smaller companies, they say, there’s a need to recoup considerable investments in clinical trials.

Revolution Medicines, based near San Francisco, has registered $4 billion in losses since its founding in 2014. That is largely because of the $3.3 billion the company has reported spending on research and development this decade. Buoyed by high investor hopes that Rasonque, the company’s first approved product, will become a blockbuster, Revolution has surged to a market valuation of $45 billion.

The company set up an expanded access program that, over the past few months, granted more than 2,000 patients free, early access to the drug. Now, with its drug approved, the company is shifting participants to getting the drug covered through insurance.

Pharmacy benefit managers play a key role in determining whether new pills like Rasonque are broadly covered, by recommending to their employer clients whether to pay for them.

Two of the largest benefit managers, CVS Health’s Caremark and UnitedHealth Group’s Optum Rx, said they had begun a review process for Rasonque.

David Whitrap, a spokesman for CVS, said Rasonque appeared to be a breakthrough. “At the same time,” he said, “it is critical that drugmakers realize that break-the-bank prices can severely limit the number of patients who are able to access these breakthroughs.”

Experts said they expected that most insurance plans would cover Rasonque, even at such a high price, because of the strong evidence that it benefits patients and the lack of alternative options.

Still, the experts said, plans could aggressively seek to limit coverage to people who meet the criteria tested in the clinical trial and approved by regulators: those with advanced pancreatic cancer who have already tried or can’t try chemotherapy. That could shut out many patients seeking it and cause battles over whether a patient is really eligible.

To make sure that ineligible patients aren’t getting the drug, experts predict, plans will use levers like prior authorization, an often cumbersome review that has been criticized for dangerously delaying care.

Revolution Medicines said it would give patients experiencing insurance delays free access to a few weeks’ supply of pills to get them started on treatment while any coverage issues were being sorted out.

Still, commercially insured patients with high deductibles could face huge sticker shock this January, when their deductible resets and they fill their first Rasonque prescription of the year. (The company said such patients might be eligible for assistance with their out-of-pocket costs.)

Commercially insured people typically have an upper limit on their annual out-of-pocket drug and medical costs. But that maximum can be high — in some cases, more than $6,000.

“It will be really a tragedy if this price makes it hard for patients to get it,” Dr. Kesselheim said.

Pancreatic cancer disproportionately affects older people, so many of the patients who will take it are covered under Medicare. Federal law should require Medicare drug plans to cover Rasonque because cancer is a protected class.

The drug offers a vivid example of how Medicare patients benefit from an annual cap on out-of-pocket drug costs created by the Inflation Reduction Act, which was passed in 2022 by Democrats without any Republican votes. That cap, which was $2,100 this year, will rise to $2,400 next year. It covers the pills and injections that patients get from a pharmacy — including Rasonque.

That means that a patient on Medicare who takes several other pricey prescription drugs may pay only a few hundred dollars a year, or even nothing at all, by starting Rasonque.

Had the drug arrived before the law went into effect, many patients would have been on the hook for over $25,000 a year for Rasonque, Dr. Dusetzina calculated.

Translation

 每年48萬美元的藥丸反映癌症藥物價格的新常態（2/2）

Revolution Medicines 公司推出的新型胰臟癌治療藥物 Rasonque，凸顯了過去二十年來癌症藥物價格的巨額上漲

 （繼續）

藥品的標價並非患者或其保險公司實際支付的價格 - 它只是談判的起點，最終由雇主或政府支付的價格會降低。雖然這種機制大幅降低了糖尿病和自體免疫疾病藥物的實際價格，但癌症藥物的最終價格通常只比標價略低而已。

癌症藥物生產商及其支持者表示，高昂的價格反映了創新蓬勃發展，這種創新已將致命疾病轉變為慢性疾病，甚至催生了治癒方法。

他們也指出，尤其對於規模較小的公司而言，是極需收回在臨床試驗方面的大量投資。

總部位於舊金山附近的Revolution Medicines公司自2014年成立以來已累積虧損40億美元。這主要是由於該公司在這十年在研發方面投入了33億美元。由於投資者對其首款獲批產品Rasonque寄予厚望，認為它將成為傑作級藥物，Revolution的市值已飆升至450億美元。

該公司設立了一項擴大用藥計劃，在過去幾個月中，該計劃已為2,000多名患者提供了免費、提前使用該藥物的機會。如今，隨著該藥物獲得批准，該公司正引導參與者透過醫療保險獲得藥物報銷。

藥品福利管理機構在決定像Rasonque這樣的新藥是否能被廣泛醫保覆蓋方面發揮關鍵作用，他們會向雇主客戶建議是否應該支付這些藥物的費用。

兩家最大的藥品福利管理機構 - CVS Health旗下的Caremark和聯合健康集團旗下的Optum Rx - 表示，他們已經啟動了對Rasonque的審查流程。

CVS發言人David Whitrap表示，Rasonque似乎是一項突破。他說道: “與此同時” ， “製藥商必須意識到，高昂的價格會嚴重限制能夠獲得這些突破性療法的患者人數。”

專家表示，他們預計大多數保險計劃都會承保Rasonque，即使價格如此之高，因為有強有力的證據表明該藥對患者有益，而且目前缺乏其他替代方案療法。

不過，專家也指出，一些保險計劃可能會積極限制承保範圍，只允許符合臨床試驗中測試並經監管機構批准的條件的患者使用：即那些患有晚期胰腺癌且已經嘗試過或無法嘗試化療的患者。這可能會將許多尋求該藥物的患者拒之門外，並引發關於患者是否真正符合用藥資格的爭論。

專家預測，為了確保不符合資格的患者無法獲得該藥物，醫保計劃將使用諸如事先授權之類的手段。事先授權通常是一種繁瑣的審查程序，並因其可能危險地延誤治療而備受批評。

Revolution Medicines公司表示，將為遇到保險延誤的患者免費提供幾週的藥量，以便他們在解決任何保險問題期間能夠開始治療。

然而，對於擁有高額自付額的商業保險患者來說，今年1月他們的自付額重置後，首次購買Rasonque時，可能會面臨巨額費用。 （該公司表示，此類患者可能有資格獲得自付費用方面的援助。）

商業保險通常對年度自付藥品和醫療費用設有上限。但這個上限可能很高 - 在某些情況下，甚至超過6000美元。

Kesselheim醫生說: 「如果這個價格讓患者難以負擔，那將是一場真正的悲劇」。

胰臟癌主要影響老年人，因此許多需要服用藥物的患者都享有聯邦醫療保險（Medicare）。聯邦法律應該要求聯邦醫療保險的藥物計劃涵蓋Rasonque，因為癌症屬於受保障的疾病類別。

該藥生動地展現了聯邦醫療保險患者如何受益於《通貨膨脹削減法案》所設立的年度自付藥品費用上限。該法案於2022年由民主黨人通過，當時並未獲得任何共和黨人的支持。今年的上限為2,100美元，明年將提高到2,400美元。此上限涵蓋患者從藥房獲得的藥片和注射劑，包括Rasonque。

這意味著，一位服用多種其他昂貴處方藥的聯邦醫療保險患者，如果開始服用Rasonque，每年可能只需支付幾百美元，甚至無需支付任何費用。

Dusetzina醫生計算，假如這種藥物在法律生效之前就已上市，許多病患每年將需支付超過 25,000 美元的 Rasonque 費用。

             So, as typical with other cancer drugs, the vast majority of the cost of Rasonque is expected to be covered through insurance. This drug offers a vivid example of how Medicare patients benefit from an annual cap on out-of-pocket drug costs created by the Inflation Reduction Act in the US. Buoyed by high investor hopes that Rasonque, the company’s first approved product, will become a blockbuster, the market valuation of Revolution has surged to about $45 billion. Apparently, high drug prices reflect a boom in innovation that has transformed deadly diseases into chronic ones and even may produce new cures for patients.