The high costs of anticancer therapies in the USA: challenges, opportunities and progress

The USA spent $99 billion on orally administered and clinician-administered anticancer therapies (excluding supportive care) in 2023 and spending is projected to increase to $180 billion by 2028. This increased spending on anticancer therapies largely reflects the high launch prices of novel therapeutics and increases in the prices of existing products, even in the absence of new evidence of clinical benefit or changes in use. Consequently, high prices have impeded Americans’ access to and affordability of necessary anticancer therapies and thus increased their risk of cost-related non-adherence, cancer recurrence and mortality. To address the rising prices and concerns regarding Americans’ spending on anticancer therapies, state and federal governments have, over the past decade, enacted legislation that caps out-of-pocket spending, expands subsidies and requires drug price negotiations. In this Perspective, we summarize US policies aimed to lower the costs of anticancer therapies, discuss the implications of such reforms and propose additional solutions needed to reduce costs and increase value. The high cost of anticancer drugs is a problem worldwide that impairs access to treatment. These high costs are particularly notable in the USA, where the prices of cancer drugs are often double those of the same drugs in other economically developed countries. In this Perspective, the authors describe the origins and scale of this problem, and summarize the various state-level and federal-level interventions designed to reduce the costs of anticancer drugs, and thus improve access for patients.