Tuesday, January 27, 2009

Compassion or Conflict of Interest? New Medicare Cancer Coverage Rules

Check out these sources on the recent Medicare rules change for coverage of cancer drugs:


Basics: Medicare has relied in the past on a single drug compendium as its authority for choosing which cancer chemotherapy drugs are covered. Critics have charged that this is wrong because some promising new drugs are excluded and patients who have exhausted all other hope are unable to get coverage for these reasonable drugs. The new rule allows many more drugs to be covered by expanding to four the number of compendia that might be viewed as authoritative. Clinical oncologists (who at least until recently earned a percentage commission as it were on chemo drugs that they administer) praise this move.

Problem: this seems less a boon for desperate patients than a boondoggle designed to help out the drug companies. The new compendia that have been added to the list include those that are compiled by people who have serious conflicts of interest with the drug industry, and even a compendium that for all intents and purposes is written by the drug companies. (One outfit that essentially sells itself to the drug industry in return for listing their products in its compendium has the nerve to call itself the "Foundation for Evidence-Based Medicine.")

As a sign that this is intended for the oncologists' and drug makers' incomes rather than real patient benefit, it seems significant that representatives of the patient advocacy groups interviewed for these press accounts generally were skeptical about the new rules.

If the Obama Administration is serious about holding down health care costs while maintaining quality care, this is one rule they will have to tackle.

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