Cancer Medicine Politics

Medicare to lymphoma patients: Go screw yourselves

Abel Pharmboy at Terra Sigillata has the full story.

In brief, Medicare has slashed reimbursement for two radioimmunotherapy drugs Bexxar (131I-tositumomab) and Zevalin (90Y-ibritumomab) to below acquisition cost. This is not some experimental therapy that’s being denied, but rather a therapy with a established clinical efficacy. Naturally, this is likely to lead to most centers abandoning these drugs. Even worse, because private insurers base their reimbursement on the Medicare reimbursement rates, usually paying some percentage above them, this decision will almost certainly lead insurance companies to slash their reimbursements for these drugs as well.

As Karl Schwartz points out, this decision not only will make it difficult, if not impossible, for patients who have failed conventional chemotherapy to obtain this second-line drug. Few people can afford to pay for it out-of-pocket.

It makes me wonder if Abel is correct when he says:

Perhaps CMS is simply counting on the fact that lymphoma patients might not have the same numbers or political clout as prostate and breast cancer advocacy groups.

Let’s hope that’s wrong.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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