This pretty interesting study from Avalere Health confirms what several others have shown. If you add a user fee to any medical procedure people use less of it. And of course their decision to use it less is not based on whether it’s medically necessary or not; it’s based on how much it costs and what their income is. The difference with this study is that it’s about the use of expensive cancer drugs which are increasingly oral, now that oncologists aren’t being rewarded as much for delivering them via infusion. Co-pays of $500 or more saw “abandonment” rates of 25% or more. Other factors creating increased rates of abandonment included lower income (duh) and whether the patient was covered by Medicare or commercial insurance. The study was (of course) funded by a gaggle of drug companies. They didn’t fund the (non-existent) parallel study of which of these drugs actually did the cancer patients any good, but it’s not logical that cost should be the determinant of whether a drug–especially presumably a life-saving one–gets used.