Lake Fong, Post-Gazette Richard Russell, 71, of Washington County, has been taking Gleevec for his cancer treatment since 2004. Now he has to pay more than $4,000 per year for the medication. "He said, 'I'll just stop taking it. We can't afford it.' That drug is keeping you alive, for crying out loud," said Beverly Russell, his wife. Click photo for larger image. More Coverage: Report: Costs soar with hospital infections

Richard Russell credits a new cancer drug with saving his life. But the medication comes at a price that makes the 71-year-old Washington County man wonder if he can afford to keep living.

The drug he takes, called Gleevec, costs about $40,000 per year. When he started taking the medication in 2004, Mr. Russell's health plan shielded him from the vast majority of the costs, asking him to pay $40 annually.

But that changed in January. Now he must pay more than $4,000 a year for the medicine, still a fraction of the drug's cost, but a huge chunk of Mr. Russell's income.

"He said 'I'll just stop taking it -- we can't afford it,' " recalled his wife, Beverly Russell, as the couple talked about the situation in their Union Township home. "But I said, 'That drug is keeping you alive, for crying out loud.' "

The drugs-vs.-dollars dilemma apparently has less to do with shortcomings in insurance than the new reality of cancer medicines, experts say. Gleevec is one of several next-generation cancer treatments that offer extraordinary hope for patients, but at extraordinary prices.

With names such as Avastin and Erbitux, the new treatments for various cancers and leukemias can require annual spending of anywhere from $10,000 to $70,000, said Robert Wanovich, director of clinical pharmacy services at Highmark.

The prospect of paying for this new crop of cancer drugs -- which will expand soon as more drugs come to market -- has prompted the region's largest health insurer to team with oncologists at the University of Pittsburgh Medical Center to determine how they can guarantee access to the drugs in a way that conserves money but stops short of rationing.

"The challenge is to find the patients [who] are most likely to benefit from them -- and make sure that they have access -- but really limit access to anybody else, so you're not wasting resources," Mr. Wanovich said.

"Before we had a handful of these expensive drugs, but now we have a whole slew of them and we have a lot more coming. The question is: How are we going to manage all of these expensive therapies?"

To this end, Highmark and UPMC have created a company called Oncology Pathways, which is developing protocols for the treatment of cancers, including the use of expensive drugs. Dr. Stanley Marks, an oncologist at UPMC, said doctors have been willing to partner with Highmark on the project because they recognize the threat that prices pose to access.

Gleevec, which is used primarily for the treatment of a rare life-threatening cancer called chronic myeloid leukemia, is a case in point, Dr. Marks said. Manufactured by the Novartis pharmaceutical company, the drug has been wonderfully successful for some patients, Dr. Marks said, yet those patients increasingly must turn to charity programs to finance prescriptions, only to find that the help is insufficient.

The idea behind the protocols for Gleevec and other drugs is to ensure that patients don't utilize the drug when it doesn't promise to make a difference -- a problem with the use of some new cancer drugs, Dr. Marks said. The program could help conserve resources and help Highmark better anticipate its costs.

"Every insurance company in the country is grappling with how to control these costs," said Dr. Marks. "If they don't get a handle on utilization, these drugs will bankrupt the system."

Highmark officials hope the protocols work because the alternative is to exempt the new drugs from existing pharmacy benefits and make them come instead with high co-payments that could curtail access, said Scott Howell, Highmark's vice president of pharmacy affairs.

The cost problems with oncology drugs are part of a broader issue with "speciality drugs," said Mr. Howell, saying similar problems exist with new treatments for multiple sclerosis, rheumatoid arthritis and hepatitis C. Expenses for specialty drugs represent about 20 percent of total drug spending, he said, and are the fastest growing area of drug costs -- increasing about 20 to 25 percent per year.

Oncology medications present one of the biggest challenges among these drugs, he added.

"On the one hand, the costs themselves create barriers for patients to access these medicines," Mr. Howell said. "On the other hand, it's really because of the profit incentive that the research and development is being done.

"The reality is: If there's a hope for better cancer care 10 years from now, it's primarily coming from the for-profit pharmaceutical companies who are doing it because of the profit potential."

That may be, but it's cold comfort to patients such as Mr. Russell, who can't imagine how they'll cover their pharmacy bills in the meantime.

Last week, after months of research to find an alternative, Mr. Russell placed an order for his next 90-day supply of Gleevec, giving the pharmacy his credit card number. He had been stretching a prescription filled in December under his old coverage, but decided he could no longer put off buying the next batch of pills.

"It was $3,499.80 for a 90 day supply. After that I'll be paying 5 percent of the cost," said Mr. Russell, noting that each subsequent 90 day supply will cost him $406.39. "I'll just make whatever minimum payments toward the credit card bill that I can."