New Medicare Rules Bar Cancer Drugs for Patients

When Jacqueline Foster was 67 years old, she was diagnosed with orbital lymphoma, a non-Hodgkins form of lymphoma found behind the eye.

Three years later, in 2002, the disease had progressed so much that Foster was forced to begin chemotherapy. After suffering through several months of chemotherapy treatment — and, of course, the loss of her hair — Foster learned there was still some residual lymphoma. In the summer of 2007, she was finally offered another treatment option.

Foster's doctor, Mark Kaminski, director of the leukemia and lymphoma program at the University of Michigan Comprehensive Cancer Center, suggested she try a radioimmunotherapy treatment drug called Bexxar. The treatment required Foster to be injected with the drug — a radioactive antibody that targets radiation to cancer cells — only twice over the course of a week.

"Within a week or 10 days, I could feel the tumors going away in my neck and my arms. I literally could feel them disappearing," Foster said. "There is no comparison. Bexxar is a one-shot deal with no or very few side effects. … This should be the front line of treatment for lymphoma."

But new Medicare rules for this class of radioimmunotherapy cancer drugs may bar thousands of lymphoma patients from receiving the treatment, which is usually reserved for lymphoma patients with tumors sensitive to radiation.

Beginning Jan. 1, Medicare will reimburse only $16,000 of the $30,000 total cost for hospitals to acquire and administer each treatment of radioimmunotherapy drugs. Currently, only two drugs — Bexxar and Zevalin — fall under this class of therapy.

Up to 10-Year Remission Rate

The Food and Drug Administration first approved Bexxar in 2003, after about 13 years of ongoing clinical trials, to prove the safety and efficacy of the drug. Kaminski, who helped develop Bexxar, said he hoped the drug's success in clinical trials would have encouraged the Centers for Medicare and Medicaid Services (CMS) not to cut reimbursement for the treatment.

"The thing that is quite terrifying for many patients and physicians is not having this option available if there cuts actually take place," Kaminski said, adding that therapies like this have proven successful for many forms of lymphoma.

"About 30 percent of patients [who receive Bexxar] achieve a remission that goes on for years, even beyond five to 10 years, despite if they may have already had prior treatment which was refractory, or not having responded to previous treatment at all," Kaminski said.

While the class of drugs is small and underutilized, many doctors, patient advocacy groups and drugmakers insist this sharp cut in reimbursement for the drugs will force hospitals to stop offering radioimmunotherapy as a treatment option altogether, and put a chill on further research in this area.

According to Dr. Samuel Silver, chair of the subcommittee on reimbursement for the American Society of Hematology and professor of medicine at the University of Michigan, Medicare cuts such as these "have a pervasive effect on the payer community."

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