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.

2023 年，美国在口服和临床医生管理的抗癌疗法（不包括支持性治疗）上花费了 990 亿美元，预计到 2028 年支出将增加到 1800 亿美元。抗癌疗法支出的增加在很大程度上反映了新疗法的高上市价格和现有产品价格的上涨，即使没有新的临床益处证据或用途变化。因此，高价格阻碍了美国人获得和负担必要的抗癌疗法，从而增加了他们因成本而异、癌症复发和死亡的风险。为了解决不断上涨的价格和对美国人抗癌治疗支出的担忧，州和联邦政府在过去十年中颁布了限制自付费用的立法，扩大了补贴，并要求进行药物价格谈判。在这个观点中，我们总结了旨在降低抗癌治疗成本的美国政策，讨论了此类改革的影响，并提出了降低成本和增加价值所需的其他解决方案。