Rationing within Medicare to Begin…?
The Washington Post just this morning posted an article about an “unusual review to determine whether the government should pay for an expensive new vaccine for treating prostate cancer, rekindling debate over whether some therapies are too costly. The review revolves around the life-extending drug Provenge, which some argue does not extend life long enough to be worth its cost. Among the quotes from the article:
- “This absolutely is the opening salvo in the drive to save money in the health-care system,” said Skip Lockwood, who heads Zero – the Project to End Prostate Cancer, a Washington-based lobbying group. “If the cost wasn’t a consideration, this wouldn’t even be under discussion.”
- “Certainly no one in the Medicare program would publicly state that the price tag would have anything to do with Medicare looking at it. But they are human beings, too. They notice things like that,” said Sean Tunis, director of the Center for Medical Technology Policy and a former chief medical officer at Medicare.
- “I don’t want to blame Obamacare, but it just kind of figures that people are taking a look at what the cost-benefit ratios are and all that sort of stuff,” said David Dykes, 69, of Lorton, a retired federal employee who was hoping to try Provenge. “That may sound pretty good to the people who want to cut costs, but it doesn’t sound too good to me. This is something that could extend my life. I’d like to give that a shot.”
- “It is extremely chilling if, after spending a huge sum of money, time and effort to get a drug through FDA approval, you’ll then have to go through it all again to see if CMS will pay for it,” said Allen S. Lichter, head of the American Society of Clinical Oncology. “Firing a shot across the bow like this is not the way to have an intelligent and meaningful discussion about how we start to address the complex issue of drug costs.”
- “To charge $90,000 for four months, which comes out to $270,00 for a year of life, I think that’s too expensive,” said Tito Fojo of the National Cancer Institute. “A lot of people will say, ‘It’s my $100,000, and it’s my four months.’ Absolutely: A day is worth $1 million to some people. Unfortunately, we can’t afford it as a society.”
- “I’d like to think cost doesn’t need to come up when it’s a slam dunk,” said H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice. “But when it’s a close call like this, it certainly has to be a factor. That’s $100,000 Medicare can’t spend elsewhere.”
- “The men most impacted by prostate cancer are African American men. If CMS doesn’t approve this, then this treatment becomes an exclusive kind of treatment for men who can afford it out of pocket,” said Thomas Farrington, president of the Prostate Health Education Network.
- “At some point, if we keep paying these very high prices for treatments that provide very limited benefit, we’re going to reach the point where we can no longer afford health care,” said Alan Garber, a professor of medicine and economist at Stanford University. “Some say we’re living through that right now.”
Sadly, many of the quotes above echo the comments of Centers for Medicare and Medicaid Services Administrator Donald Berwick, who has talked about “rationing with our eyes open” and said that “at some point, we might say…that we wish we could afford [a benefit or therapy] but we can’t.” As medicine becomes more personalized to patients’ specific conditions and needs – one of the reasons Provenge is such a costly therapy – Americans may see more debates about these issues, and more attempts to restrict access to important therapies based on cost grounds.