Note: Is this the beginning of even more sub-standard care, due to the onset of what is now commonly called, “Obama Care“? (Ed.)
BREAST CANCER patients in some states may soon lose Medicare coverage for the expensive drug Avastin, after the Food and Drug Administrations decision to revoke the drugs approval for that disease.
Palmetto, one of the companies that determine Medicare coverage for different regions, said in a notice posted on its Web site that it would no longer pay for use of Avastin to treat breast cancer starting Jan. 29.
The decision affects South Carolina, Ohio, West Virginia, California, Nevada and Hawaii, according to Genentech, the manufacturer of the drug. The company said it understood that women already on the drug or who start treatment before Jan. 29 would be able to complete their course of treatment but no new patients would be covered after that.
The action follows the decision by the F.D.A. last month to revoke the approval of the drug as a treatment for breast cancer. The F.D.A. said new studies showed the drug, also known as bevacizumab, was not every effective and could cause dangerous side effects.
The F.D.A. decision was greeted with outcries from some breast cancer patients and their doctors, who said it would deprive women of a drug that might help them. Some patient advocacy groups, however, applauded the decision, saying women need more effective drugs.
Some Republican lawmakers said the decision was based on the cost of the drug and represented the start of rationing under the new health care law. The F.D.A. said cost was not a factor in its decision.
The decision of Palmetto to stop covering that use of Avastin appears to go against assurances given by F.D.A. officials last month that the Centers for Medicare and Medicaid Services would not consider changing reimbursement for Avastin until Genentech had exhausted its appeals. Until then, the F.D.A. officials said, the breast cancer approval remains in place.
A Medicare spokeswoman said Thursday evening that officials were not immediately available to comment. Palmetto executives could not be reached.
Medicare is not supposed to consider cost in coverage decisions but Palmettos move is likely to raise suspicions that costs were considered. The companys future local coverage determination notes that This policy lists a number of higher cost drugs and biologicals used to treat cancer and other acute and chronic conditions subject to prepay edits.” So clearly Medicare contracts are cognizant of costs and want to make sure such expensive drugs are not overused.
Even if it loses the approval for breast cancer, Avastin will retain approvals as a treatment for colon, lung and other cancers. So doctors could continue to use it off-label for breast cancer.
But insurers would be less likely to pay for such off-label use. That would make the drug, which costs about $88,000 a year, unaffordable for many women.
Elizabeth Thompson, president of the advocacy group Susan G. Komen for the Cure, said the move by Palmetto, if true would be unfortunate” for women with breast cancer.
This is the consequence we were concerned about, and well continue to watch this situation very closely. We continue to urge third party payers to fund Avastin for those women who benefit.”
Some private insurers, such as Regence, a Blue Cross Blue Shield company in the Northwest, are also moving toward denying reimbursement for Avastin when used to treat breast cancer.
Genentech, a subsidiary of Roche, said in a statement that it believed that treatment decisions for a woman with breast cancer should be made between her and her doctor,” and that Avastin should be part of that discussion.”
Written by Andrew Pollack, and publiched on The New York Times, January 6, 2011.
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