The travesty has come true, according to Karl Schwartz and Betsy de Parry of Patients Against Lymphoma.
The Centers for Medicare and Medicaid Services (CMS) has gone ahead with their plans to slash by half reimbursements to hospitals for two radioimmunotherapy drugs. For many hospital, reimbursement rates will be lower than their acquisition costs. We discussed this possibility back in August but had thought that CMS administrators would acknowledge the outcry from the lymphoma survivor/advocacy community, not to mention very strong statements from ASCO (American Society of Clinical Oncology) and ASH (American Society of Hematology).
“It (the ruling) will eliminate one of the few treatment options and perhaps the only treatment option for some patients with non-Hodgkins lymphoma who have failed chemotherapy treatment.” – Andrew I. Schafer, President, ASH
The two immunotherapy drugs in question are Bexxar® (131I-tositumomab) and Zevalin® (90Y- or 111In-ibritumomab tiuxetan) – both drugs are radioactive antibodies that target the CD20 protein on the surface of normal and malignant B-lymphocytes, killing the cells by the radioactive emissions of their respective radionuclides. The clinical benefits and cost-effectiveness of these drugs has been well-established.
But just to be sure patients are confused where CMS really stands, this statement says it all:
CMS warns that “it may terminate the provider agreement of any hospital that furnishes this or any other service to its patients but fails to also furnish it to Medicare patients who need it.”
Thus, if radioimmunotherapy (RIT) treatments are unavailable to Medicare patients, they will also be unavailable to anyone else. As noted on the Lymphomation blog:
(1) Patients in need will be denied access to a life saving therapy. (2) Future patients will be denied access to RIT and similar targeted drugs. (3) as ASH states, “It (the ruling) could have a chilling effect on the development of future drugs and radiopharmaceuticals for treating other forms of cancer and other diseases.”
So, yes, this news is certainly devastating for lymphoma patients, even those who might wish to pay out-of-pocket for RIT since hospitals may now be less likely to stock Bexxar or Zevalin.
But as Karl and Betty point out above, this ruling sets a “chilling” precedent in that such reimbursement guidelines may have long-term impact the desire of drug companies to invest in lymphoma therapies or other radiopharmaceuticals.
I still have yet to see any convincing argument, clinical or financial, to account for CMS’s reimbursement decision. 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:
Frankly, the CMS decision would never stand if the treatment cuts were for breast cancer patients, a highly organized political group (to their credit).
Be warned, this CMS policy-of-error could easily be applied to treatments for other conditions, and future therapies for lymphomas as well. Will CMS, for example, miscalculate the costs for patient-specific cancer vaccines should they win approval?
Every cancer patient should be paying attention to the follow-up discussion on this issue. It could be the treatment for your cancer that is targeted next by CMS.
There may still be time to appeal to your Senators. But if other lymphoma patients or anyone else have ideas on where to go from here, I’m all ears.