Respectful Insolence

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.


  1. #1 Mike
    November 12, 2007

    It is not just this instance of decreasing reimbursements. Earlier this year the retail pharmacy lobby helped to defeat a bill pushed by the Democratic congressional leaders that would have required Medicare to reimburse retail pharmacies at a level that was less than the average price to dispense a drug.

  2. #2 Anjou
    November 12, 2007

    Thank you for posting this!!

  3. #3 James
    November 13, 2007

    I think this sort of thing shows pretty clearly that while the US healthcare system is called “free market” by many, it is heavily influenced by government.

    I suspect a significant amount of the problems with your country’s health system could be fixed by lessing the influence government has on private healthcare decisions.

  4. #4 Dianne
    November 13, 2007

    I suspect a significant amount of the problems with your country’s health system could be fixed by lessing the influence government has on private healthcare decisions.

    Or…not. Five and ten year survival rates for lymphoma are actually higher in Germany, which has one of the world’s oldest universal health care systems. Looks like that gap will be getting bigger.

  5. #5 Betsy de Parry
    November 13, 2007

    Your blog’s title says it all – but it’s not just lymphoma patients who will suffer. This will create a disincentive for the development of innovative therapies, thereby risking the lives of patients will many types of illnesses.

  6. #6 Dianne
    November 13, 2007

    Though I do wonder why you didn’t go with the (to me) more obvious reference and make the title “Medicare to lymphoma patients: Drop dead.” Since that is, effectively, what medicare is telling them to do.

  7. #7 Andrew Dodds
    November 14, 2007

    James –

    The government has to get involved in healthcare as long as you have elections. The reason being that having people with insufficient/no insurance carried out of hospitals and left to die on the street is something of a vote-loser.

    This problem (Well, problem for free-market fanatics) means that the US gets the worst of both worlds – a fantastically expensive private insurance system and a kludged public system without proper coverage, which manages to cost twice as much as any other country with the same standards of care.

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