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Medicare Cuts Payout on 2 Cancer Drugs
December 7, 2007
New Medicare rules for a small but promising class of cancer drugs called Bexxar and Zevalin may cause thousands of lymphoma patients to lose access to the treatment. The drugs are given to treat non-Hodgkins lymphoma, the fifth-most-common cancer, and are usually prescribed for patients who have not responded to other therapies and who have few remaining treatment options. Clinical trial data show that they put the disease into remission for years in many of those patients.
After Jan. 1, Medicare will reimburse hospitals about $16,000 but they cost about $30,000. (Note that because Bexxar and Zevalin contain radioactive material, the drugs must be administered by specially licensed technicians and doctors, and thus are usually given in hospitals).
Medicare officials say they are not trying to prevent hospitals from giving Bexxar and Zevalin, but they say that $16,000 is a fair price and is based on the actual prices hospitals have paid for the medicines this year. But the companies say Medicare's data must be inaccurate and that no hospital will offer the drugs to Medicare patients if it is losing $10,000 or more on each treatment. Under federal rules, hospitals that do not offer a drug to Medicare patients are barred from offering it to other patients, even if their insurers fully cover the cost of treatment.
Doctors, lymphoma patients and advocacy groups say they do not understand Medicare's decision. About 60,000 people are diagnosed with non-Hodgkins lymphoma every year, and 20,000 people die of the disease. The Lymphoma Research Foundation says the drugs are the only option for some patients. Advocates for the drugs worry that Medicare's decision will end most use of the drugs and chill the development of other similar drugs.
The Centers for Medicare and Medicaid Services said that the agency recognized the value of the drugs, but Medicare does not want to overpay. But most other drugs are not reimbursed on the basis of what hospitals say they have paid. Instead, companies report the average price of their drugs to Medicare. Medicare then reimburses doctors and hospitals. So far, Medicare has refused to switch to that system for Bexxar.
Source: ALEX BERENSON New York Times
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LINKS FROM PAST ARTICLES
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- Part B Premiums To Rise (October 2007)
- Part D Premiums Lower in 2008 (August 2007)
- Medicare Changes Coverage For Anemia Drugs (August 2007)
- How Can Medicare Help Me Stay Healthy? (July 2007)
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- 5 Ways to Lower Your Drug Costs (April 2007)
- New Edition of the Guide to Home Health Care Agencies (May 2007)
- Social Security and Medicare Trustees’ 2007 Report Summary (May 2007)
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