A year after a cancer diagnosis, it's big pharma that could kill me.

Congress needs to cap drug prices.

We just finished the fourth season of Goliath with Billy Bob Thornton.

It’s great. I’m not giving up any spoilers but the story concerns the nation’s opioid epidemic and the evil role of Big Pharma.

Thornton plays the lawyer, Billy McBride. Billy is David to Big Pharma’s Goliath and the speech he gives in the final episode…

Well, I promised no spoiler.

It was one year ago that I was driving down Lincoln Avenue with Anne when my cell phone went off and it was my doctor. Or my personal care physician as they are called now.

Most of my communications with my PCP are through an online system called MyChart.

An actual phone call with the PCP voice on the other end could only be bad news.

I had been experiencing a bad cough all summer and a constant hoarse voice. My PCP had sent me for a CT scan and an pulmonary test. The results showed nothing wrong with my lungs.

But, he said the CT scan showed a suspicious mass on my kidney.

“I’m not losing any sleep over it,” I remember the doc saying.

I pulled over.

He may not have lost sleep. But I did.

He recommended I go see a urologist and get an MRI.

I turned to Anne and said, “Fuck!”

November 7th will be one year since they removed my left kidney with a cancerous tumor attached that was the size of an orange.

It had not spread beyond the kidney and I still have another kidney.

I have an MRI scheduled next month because there is always a chance it will return.

I had a sixth month check up and things were good. I have every reason to think November’s results will be the same.

But, you can guess. There is always anxiety because I never had symptoms the first time, so I won't know for sure if there is no cancer return until I meet with the urologist following the next MRI.

From a financial point of view, Medicare and my Medicare Advantage shielded us from the $100,000 the hospital lists as the charge for the procedure.

Following the surgery I was done with it. No chemo. No pills.

Which brings me to the issue of Medicare and drug costs.

Part of the legislation that Congress is negotiating now is to cap drug prices.

The Republicans are against a cap as are a couple of Democrats in the Senate.

You might not know that when Medicare Part D was created it banned Medicare from bargaining drug prices. The bargaining is done by the insurance companies.

Jesus.

Where’s Billy McBride when you need him?

Many Americans with cancer or other serious medical conditions face prescription drug costs that will literally kill them.

It can be worse for Medicare patients. Unlike private health insurance, Part D drug plans have no cap on patients’ 5% coinsurance costs once they hit $6,550 in drug spending this year.

The problem is made worse by the incredibly high cost of some cancer drugs. Cancer patients pay the percentage of the list price, not the cost to the insurance company.

The Kaiser Family Foundation reports that prices for 54 orally administered cancer drugs shot up 40% from 2010 to 2018, averaging $167,904 for one year of treatment, according to a 2019 JAMA study.

Bristol Myers Squibb, the manufacturer of the cancer drug, Pomalyst, has raised the price 75% since it was approved in 2013, to about $237,000 a year.

As a result of rising prices, 1 million of the 46.5 million Part D drug plan enrollees spend above the program’s catastrophic coverage threshold and face $3,200 in average annual out-of-pocket costs, according to KFF.

The hit is particularly heavy on cancer patients.

In 2019, Part D enrollees’ average out-of-pocket cost for 11 orally administered cancer drugs was $10,470.

The median annual income for Medicare beneficiaries is $26,000.

Here is how good news becomes bad news for those of us on Medicare.

If I didn’t have my cancer surgically removed and required chemo instead, I would have it administered in a hospital or doctors’ office and my Medicare would cover it and my out-of-pocket costs would be capped by Medicare and Medicare Advantage.

But during the past several years, dozens of effective drugs for cancer and other serious illnesses have become available in oral form at the pharmacy.

Good news?

That means Medicare patients increasingly pay the Part D out-of-pocket costs with no set maximum.

With the high cost of drugs today, that 5% can be a third or more of a patient’s Social Security check.