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.