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What If the Best Cancer Drug Is the One You Can’t Get?
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Released: July 15, 2025

Expiration: July 14, 2026

John Marshall
John Marshall, MD
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MedBuzz: What If the Best Cancer Drug Is the One You Can’t Get?

 

John Marshall, MD: We've been talking a lot and thinking a lot about access to cancer care. And let's start hometown—let's start here in the good old US of A—and talk about unequal access to cancer care. Here, we all know that what color you are, what your race is, what your gender is, who your parents were, what type of insurance you have, urban versus rural—we all know about those differences in access to cancer care. A new one that's emerging is specialization of the team that you're seeing. So, general oncology teams versus disease-specific oncology teams tend to produce different outcomes, simply because everything is moving so fast, the subtleties are something that the specialized team can keep up with, that a generalist would struggle with. And this is an important issue that we need to figure out, as a nation, how to distribute that specialized knowledge to everyone so that we level that playing field as well.

 

We all know about the threat that's out there right now with health insurance changing—where Medicaid is being threatened. Just yesterday, Planned Parenthood was talking about, well, the Supreme Court says, yep, you don't have to have Medicaid for Planned Parenthood. Like, that's the Supreme Court's decision on—I give up anymore. But so, where's that gonna trickle down to in the expensive world of cancer medicine?

 

And so, we'll talk about ex-US, but I want to start with us a little bit more, because I was on a call the other day with a congressman—U.S. Congressman from Georgia’s First. That’s the southeast coast of Georgia. It's also where I—so one of my favorite places to escape. But the congressman there is a guy named Buddy Carter, and he was a pharmacist before he became a politician. He was saying—Republican—and he was basically saying that we can't afford, in this country, healthcare. We can't afford cancer care, for sure. We're spending a lot more than we have, which means we're just continually going into debt every time we add a new medicine or do a new CT scan or whatever it is. Yep, insurance is covering it. Healthcare systems are being paid for it. But we're going into overall debt because of that. And his main shtick, which sort of upset me, was all about cleaning up the rolls—making sure that people who don't deserve U.S. healthcare aren't getting it. So, if you're a non-national or you're not working or whatever it is, that you don't get access to the support for your healthcare without demonstrating your worth, your value to the system. So, that sort of got me on my heels.

 

What also putting me further back on my heels was that he was ranting about 340B pricing. We all know that that is an uneven system in our country, where certain health system sites get different prices than other sites, making a bigger markup to pay for the infrastructure of cancer care. That was the reason it was originally developed. But, of course, it creates an uneven reimbursement system right now here in the good old US of A—even within the Beltway, we have different rules, different healthcare sites.

 

He also went on about PBMs, the pharmacy benefit managers, the middle people who are taking their skim off the top for managing cancer care and the expense of therapeutics. So, they clearly, up on Capitol Hill, are upset about this and anxious about this. And they want to blow it all up like they do with everything, but they don't actually have a plan for what they would do in place of that.

 

As we thought about this, we thought about: okay, if we're gonna blow up the U.S. system that's covering so much of our world's healthcare economy and research, what are we gonna replace it with? So, we thought it would be interesting to talk to folks from around the world and get their opinions about this. So, certainly continue to listen in and listen to those interviews from people who are very well respected around the world.

 

But one other thing that we thought about is that if you are from a poorer country and you know about these novel therapies, and some manufacturer is willing to make your biosimilar or your generic for you outside of the patent laws that exist—at least in this country—do you know if you're getting a good product or not? And so, there is increasingly data to say that it's inconsistent—that if you're a physician in a less wealthy part of the world and you've ordered some fancy drug that's being provided by some manufacturer, not the original one—maybe it's not active, maybe it's too active, maybe it's toxic. So, it's unpredictable.

 

And so, in the desire to have access to these very positive therapies, these very positive interventions, it makes people make risky decisions about, well, better to try it than to not try it, because I got nothing better than that.

 

So, we think this is a major issue for us as a global market as well.

 

So, lots going on out there as we try and bring innovation forward, try to keep our advantages that we have been able to achieve, and distribute them evenly and more effectively to more people—not only in the United States but around the world.

 

So, I hope you will continue to listen to Oncology Unscripted as we do a deeper dive into this issue of access and healthcare decision-making around the world.