Medicare Balks at Paying for Lymphoma Drugs Two new and innovative anti-cancer drugs work against a type of lymphoma where other drugs fail. But after Jan. 1, Medicare will cut what it pays for the expensive treatments. Medicare's decision could leave thousands of patients unable to get a therapy that others say saved their lives.
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Medicare Balks at Paying for Lymphoma Drugs

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Medicare Balks at Paying for Lymphoma Drugs

Medicare Balks at Paying for Lymphoma Drugs

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A couple of new and innovative anti-cancer drugs have come on the market recently. They work against a type of lymphoma where other drugs fail.

But NPR's Joanne Silberner reports that the drugs have a couple of problems.

JOANNE SILBERNER: Five years ago, Betsy Diperry of Ann Harbor, Michigan didn't think she had much of a chance of surviving a type of cancer known as advanced follicular non-Hodgkin's lymphoma. Fevers and hot flashes and joint pain kept returning, despite several difficult rounds of chemotherapy.

Ms. BETSY DE PARRY (Cancer Survivor): I knew that we were running out of options and if these first two types of chemotherapy didn't work, what would?

SILBERNER: De Parry's doctor told her about a new drug that had just come on the market.

Ms. DE PARRY: Zevalin. Radioimmunotherapy came to my rescue.

SILBERNER: Zevalin is a type of radioimmunotherapy. A radioactive compound is hooked to an antibody that latches on to cancer cells, delivering radiation directly to those cancer cells.

Zevalin and a similar drug called Bexxar are approved for use when non-Hodgkins lymphoma comes back after treatment with other drugs. And it nearly always comes back.

Several studies show that more than half of people who stop responding to other drugs are helped by Bexxar. The drugs are popular with oncologists such as Joseph Connors of the British Columbia Cancer Agency in Vancouver.

Dr. JOSEPH CONNORS (University of British Columbia): On recurrence, under the right circumstances - that is, when several of the drugs have already been tried, the best choice next is clearly Bexxar/Zevalin.

SILBERNER: Bexxar and Zevalin, though, have two major problems. The first: they're harder to administer than regular chemotherapy. Because of the radiation, they have to be given in special facilities with trained staff.

Again, Joseph Connors...

Dr. CONNORS: It's a lot easier for a doctor to sit in his office, decide what should be done, write out the directions for it, and get on to his next patient.

SILBERNER: Instead, a doctor has to find a hospital where the therapy is offered, which means losing his patient and the income. Connors, patient advocates, the manufacturers, all say most people who could benefit from these drugs aren't told about them by their doctors.

The second problem is on the horizon. Starting January 1st, the government's Medicare program will pay hospitals $16,400 to administer the drugs. The reason that's a problem?

Dr. CONNORS: The price of Bexxar that GSK sells into the market for a single course of treatment is $26,780.

SILBERNER: Ten thousand more than Medicare will pay, according to Dave Moss(ph)of GlaxoSmithKline, which makes Bexxar. The problem here is how Medicare calculated its payment for 2008. Medicare looked back at what it's been paying hospitals for the last few years, says Herb Kuhn, deputy administrator of Medicare.

Mr. HERB KUHN (Medicare Administrator): We have paid and will continue to pay based on what the hospitals tell us they purchased these products for.

SILBERNER: Neither hospitals nor Medicare have been able to explain why last year's charges appear to be $10,000 lower than the price of the drugs. Now, the manufacturers could lower their prices, but that's not likely because of the radiation involved and the difficulties of producing antibodies.

Glaxo's Dave Moss says the research costs were high and the drugs are expensive to produce.

Mr. DAVE MOSS (GlaxoSmithKline): I don't think that lowering the price is really going to correct the underlying issue, which is a flaw in the methodology.

SILBERNER: Several hospitals refused to say what they're going to do come January 1st, when Medicare reimbursement drops.

Meanwhile, Medicare is going to check the methodology behind its figures.

Again, Herb Kuhn...

Mr. KUHN: We're going to go back. We're going to re-look at those claims to make sure that we're interpreting the information we got from them correctly, because the last thing we want is to underpay or overpay for a particular procedure.

SILBERNER: And former patient Betsy de Parry is going to continue to do what she's been doing since she heard about Medicare's plans last month: send letters to legislators and get others to do the same. It's because she believes the drugs saved her life.

Joanne Silberner, NPR News, Washington.

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