Budget Cuts Threaten High-Tech Cancer Therapies
Imagine that you were diagnosed with cancer, and were told that you had one of two treatment options: 1) you could receive a one time dose of a medicine that will go directly to the tumor cells and kill them only, having very few noticeable side effects or 2) you could undergo months of exposure to toxic chemicals that will kill the tumor cells and many other healthy cells as well, resulting in hair loss, bowel damage, nausea, and vomiting. Which would you choose?
Unfortunately, choice number one may no longer be an option for lymphoma patients due to government funding cutbacks, and the development of such treatments for other cancers is in jeopardy as well.
Radioimmunotherapy (RIT) is a relatively new approach to cancer treatment, new enough that the government is having difficulty categorizing it correctly. (RIT involves targeting cancer cells with special antibodies that carry tiny, lethal radiation doses to individual cells.) In fact, drugs like Bexxar and Zevalin have been misclassified by CMS as “supplies” rather than medications, and so the reimbursement allowed doesn’t come close to covering the cost of the therapy. Although there are many new targeted therapies under development, investors are worried that the drugs will never be used in patient care because the country’s number one payer (Medicare) is unwilling to cover their costs. Other health insurers often follow the government’s lead when it comes to treatment coverage policies. If no one will pay for the cost of the drug, then ultimately no one can afford to make it available.
Similar funding problems are beginning to limit access to diagnostic nuclear imaging modalities like PET scans, PET CT, cardiac SPECT scans, and bone scans. Reimbursement levels that do not cover the cost of the imaging drugs means that facilities cannot afford to offer these diagnostic technologies to patients, and centers are slowly reducing the number of tests they offer. Nuclear imaging studies are often critical in diagnosing heart problems, infections, and early detection of cancer. Senator Arlen Specter had his cancer recurrence diagnosed at the very earliest stages thanks to PET scanning technology. Early treatment offers him the best possible prognosis, but he is in a dwindling group of people who have access to this imaging modality.
I spoke with Dr. Peter Conti, professor of radiology at the University of Southern California, and former president of the Society of Nuclear Medicine, from Spain this week – as he is attending the 6th International Workshop for Nuclear Oncology, a lymphoma conference where the crisis in reimbursement for targeted cancer therapies is being discussed, along with exciting advances in treating patients with lymphoma. The two different RIT drugs (Bexxar and Zevalin) for non-Hodgkin’s lymphoma are in jeopardy of not being available to Medicare patients due to proposed cuts in reimbursement. Recent plans to cut payment for these drugs have been halted by a temporary moratorium from Senator Kennedy. Here’s what Dr. Conti had to say:
“Let’s face it, lymphoma is not as high profile as other cancers such as breast, colon, or prostate. However, we’ve found a fantastic treatment option for it, and there are implications for the more common cancers, but that treatment option is being denied to lymphoma patients because facilities cannot cover the costs of offering it. I’d like the entire cancer community to rise up in support of lymphoma patients so that Congress will tell Medicare to fix the funding problem. If this doesn’t happen, it’s only a matter of time until novel RIT treatments are no longer an option and we’ll be stuck in the dark ages of non-specific chemotherapy and radiation treatments that harm the good cells with the bad. Personalized, targeted therapy is the future – and we’re missing the opportunity to further develop these novel therapies due to budget cuts.”
I reached out to the current president of the Society of Nuclear Medicine, Dr. Alexander J. McEwan, for comment:
“Molecular imaging offers critical tools for the early detection, diagnosis and treatment of many life-threatening diseases, including cancer. SNM recommends that CMS establishes appropriate reimbursement for all forms of nuclear and molecular imaging and radioisotope therapies at levels that allow optimum access and improved outcomes for all patients.”
Denial of RIT to lymphoma patients may be the first sign of a new trend limiting the development of high tech therapeutic innovations. Will America’s research engine run out of gas before we figure out how to treat cancer without side effects? Should we buy one more tank to get us over the crest of the targeted therapy hill? This is a judgment call that affects all of us at a time of great need and limited resources. What’s your take?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
http://www.treat-cancer.nl
So we’re on the same page, this is a one-time administration, not monthly. That’s a key advantage financially as well as for the patients.
Agree Dr. Conti. Overall costs must be considered, and what we can afford as a society striving to provide the best care to everyone. As the medical director of San Diego County Medical Services, I often see requests for therapies as if cost were no object. The cost/benefit and risk analyses are part of any smart theraputic decision making.
I certainly agree with Dr. Jones. It is tragic that therapies such as Bexxar and Zevalin may potentially not be available to patients due, in large part, to lack of sufficient reimbursement.
To give you an idea of how little CMS knows about these therapies, we recently received a letter from the OIG regarding our charges for a Bexxar in 2006. Because the charges were in excess of $10,000.00, for reasons that are obvious to us, they are being called into question. We were barely reimbursed our costs for the radiopharmaceuticals, but that was too much for them. I sent them our invoices for the radiopharmaceuticals along with records on the particular patient. It will be interesting to see how they respond.
Like many other IDTF’s, our reimbursement is so poor now that we considered not offering radioimmunotherapies any longer. However, in the end, we couldn’t deny the service to our patients because we believe it is an excellent therapy. One of our patients even asked why these therapies weren’t done more often. She was very pleased with her outcome, and she was genuinely baffled as to why it is so restrictive. Anyone who is opposed to these therapies should talk to the patients who have had them. All of our patients have been pleased with their results!
Patients Against Lymphoma worked closely with Congress to get payment for RIT extended, but as I’m sure you know, the extension expires June 30. In February, the organization prepared and submitted a report to CMS and to members of Congress which may be of interest:
http://www.lymphomation.org/cms-rep.pdf
RIT must be safeguarded, saved and used more than it is. Currently, less than 10% of the patients who are eligible for it actually get it which is very unfortunate for the patients who might benefit from it.
On a personal note, I would not be alive without RIT. Five and a half years ago, it saved my life. I’ve had no additional treatment.