Drug Price Inflation and the Cost of Assisted Death for Terminally Ill Patients—Death With Indignity

Abstract

The Washington State Death with Dignity (DWD) Act passed into law in November 2008 and allows terminally ill adults with a life expectancy of fewer than 6 months to requestlethaldosesofbarbituratemedicationstoendtheir lives. Participants have cited concerns about loss of autonomy,dignity,andabilitytoengageinactivitiesthatmake life enjoyable as reasons for participating in the program. 1,2 Since 2009, the number of DWD prescriptions dispensed in Washington State has steadily increased, and the majority of patients (approximately 75% with cancer diagnoses) to whom the medications are dispensed will ingest them. 1 The DWD program has generally been considered successful and patients have reported feeling grateful to have an option for physician-assisted death. 2 Today, however, patients and their families are raising new concerns about the high cost of DWD medication and the unaffordability of ending their lives in this way.We reviewed data on all DWD prescriptions written and dispensed at the Seattle Cancer Care Alliance, the outpatient oncology clinic for the Fred Hutchinson Cancer Research Center and the University of Washington. Since 2010,atotalof73DWDprescriptionshavebeendispensed to terminally ill patients with cancer. Consistent with broader prescribing patterns in Oregon and Washington, secobarbital (Seconal), an oral barbiturate, was the most commonly prescribed DWD medication (48%) (Table ). Oral pentobarbital was the next most commonly prescribed barbiturate, though prescriptions dropped sharply in 2014 after the manufacturer halted sales of the drug in response to its increasing use in state executions. Mean out-of-pocket cost for secobarbital increased steadily between 2010 ($387.52) and 2016 ($2878.09). Since DWD medicationsarenotconsideredtherapeutic,theyarerarely coveredbypublicorprivatehealthinsuranceplans,andpatients must bear the entire cost of the prescription. Due to the increased cost of secobarbital in 2015 and 2016, pharmacists at the Seattle Cancer Care Alliance referred 16 patients during this time to outside compounding pharmacies to receive a cocktail of phenobarbital, chloral hydrate, and morphine sulfate at a cost of $500.

Aggregating 23 years of data on medical aid in dying in the United States

“…Most MAID requesters must pay for MAID prescriptions out‐of‐pocket, as Medicare and other federal health insurance programs do not cover aid in dying costs. These out‐of‐pocket costs have risen dramatically, and some drugs are off‐patent but lack generic formulations 3 …”

“…These out-of-pocket costs have risen dramatically, and some drugs are off-patent but lack generic formulations. 3 Individuals with cancer are over-represented among MAID utilizers. In the United States, cancer accounted for 17.8% of all deaths in 2020, 4 yet 74% of MAID deaths have a diagnosis of cancer.…”

Insurance Coverage and Aid-in-Dying Medication Costs—Reply

“…In Reply We appreciate the thoughtful comments of Grube and Cardenas in response to our recent article …”

Insurance Coverage and Aid-in-Dying Medication Costs

“…To the Editor We read with great interest the article by Shankaran et al on the appalling price inflation for secobarbital, the drug most commonly prescribed for terminally ill patients who have requested and qualified for medical aid-in-dying in authorized states. Medical aid-in-dying is currently authorized in 6 states, either through statute or court decision, including Oregon (1994, ballot initiative), Washington (2008, ballot initiative), Montana (2009, state Supreme Court decision), Vermont (2013, legislation), California (2015, legislation), and Colorado (2016, ballot initiative).…”