Thursday, August 16, 2007

A HUGE Problem for RIT

Much has been written recently about the underutilization of the two radioimmunotherapy drugs, Bexxar and Zevalin. As if they haven’t faced enough hurdles, they now face the biggest hurdle of all. Medicare is proposing that the reimbursement for Bexxar be cut by more than half. Zevalin faces the same problem, although I have exact numbers for only Bexxar. If this proposed change is adopted, it will sound the death knoll for these drugs once and for all. If ever this treatment needed help, it is now. What follows is an explanation of the problem and how you can help.

Each year, the Center for Medicare and Medicaid Services (CMS), revises its reimbursement schedule. For next year, it is proposing to reimburse Bexxar in the amount of $13,156.51. The total cost of Bexxar is $26,780 plus a $3000 compounding fee for a total of $29,780. This means that hospitals would have to subsidize the remaining $16,623.49 after reimbursement. Zevalin faces the same shortfall.

Here's the reality. Hospitals will not subsidize their Medicare patients which will effectively deny Bexxar (as well as Zevalin) to these patients. And hospitals will not offer drugs to privately insured patients unless Medicare patients have access to the same drugs. This means that Bexxar and Zevalin will effectively be denied to everyone. If this proposed change occurs, it is the end of these drugs - as well as the promising future of radioimmunotherapy, at least until our government decides to catch up to advances in medicine. It means that lymphoma patients will not have access to these important drugs!

This is one time when many voices are needed and that yours can make a difference. CMS is inviting public comments on these proposed changes until September 14 and I certainly plan to protest them. I hope that each of you will join me. We cannot allow these effective treatments to disappear.

I am currently drafting a letter to CMS and will post it in the next day or two with information about where you can send your comments.

In the meantime, if anyone wants more details, please email me and I will send you a complete breakdown of the proposed changes and the link to the CMS document.

This news is devastating to RIT but more importantly, devastating to lymphoma patients. If the proposed change takes effect, none of us may be able to get these drugs if we need them. Please stay tuned for more information and a draft of my letter that you can modify for submission to CMS.


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