Medicare: Easy way to cut

iVillage Member
Registered: 10-25-2006
Medicare: Easy way to cut
64
Sat, 07-02-2011 - 9:14am
This is absurd....spending $93,000 to extend the life of a very sick person only 4 mos.

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From Medscape Medical News CMS to Pay for Provenge for Metastatic Prostate Cancer

Nick Mulcahy

June 30, 2011 — In a final decision memo, the Centers for Medicare and Medicaid Services (CMS) announced today that it will provide coverage for the use of Provenge (Dendreon), the prostate cancer vaccine known generically as sipuleucel-T, in patients with asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer.

"We are optimistic that innovative strategies may improve the experience of care for our beneficiaries who have cancer," said Donald M. Berwick, MD, administrator of CMS, in a press statement about the coverage decision of the unique treatment, which is derived from a patient's own white blood cells. "CMS is dedicated to assuring that these patients can seek the treatments they need in accordance with their wishes."

The announcement means that the coverage decision is in keeping with the US Food and Drug Administration's (FDA's) indication for the vaccine.

"CMS is covering Provenge nationally only for those indications supported by evidence and consistent with the FDA label," said Patrick Conway, MD, chief medical officer and director of Office of Clinical Standards & Quality at CMS.

Off-label usage will not be covered nationally but instead will be left for local Medicare administrative contractors to decide upon, according to CMS.

Off-label usage is likely to be highly scrutinized. "We do not believe there is any persuasive evidence for the off label use of sipuleucel-T at this time," reads the National Coverage Decision memo from CMS.

The new coverage decision comes after an unusually protracted review by CMS of Provenge, which costs $93,000 for a typical course of 3 treatments.

The vaccine was subject to a CMS National Coverage Analysis, which included a review by a federal panel known as the Medicare Evidence Development and Coverage Advisory Committee.

In November 2010, the committee gave what amounted to a middling vote of confidence for the on-label use of Provenge and a rejection for off-label use.

The combination of the high cost of Provenge and an atmosphere of high-intensity federal budget scrutiny contributed to widespread news coverage of the therapy and the CMS review.

However, there have also been questions about Provenge data because of potential confounding effects of subsequent treatments of some patients in clinical trials. In a technology assessment quoted in the CMS decision memo, the assessment authors noted that the benefit from Provenge occurred in clinical trials that included chemotherapy. "This treatment effect occurs in the context of use of post-progression chemotherapy," the document reads.

Although referred to as a vaccine, sipuleucel-T is actually an autologous active cellular immunotherapy, which means that it is made from the patient's white blood cells and stimulates a patient's immune system to respond against the cancer. The treatment needs to be manufactured individually for each patient.

Sipuleucel-T was the first product approved by the FDA in a new therapeutic class known as active cellular immunotherapies.

In a pivotal phase

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http://www.pnhp.org/news/2009/october/meet_the_new_health_.php

http://www.youtube.com/watch?v=DQTBYQlQ7yM

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iVillage Member
Registered: 03-02-2009
Mon, 07-04-2011 - 5:35pm

I ask again. Do you propose that taxpayers foot the bill ?

Not me, that's what you want. I am for getting the government out of health care as much as possible. The left wants the government controlling the entire thing, single payer I believe you like to call it. Single decider on whether or not you get a treatment, too.

I am also bemused by the inherent contradiction between finding solutions to the national debt; and what appears to be a mighty expansive and expensive definition of Medicare!

Of course you are. So far, Obama's solution to the national debt is deficit spending of $1,600,000,000,000.00. He really cares about the debt, doesn't he?

We have democrats in government that are pushing us closer and closer to the brink, and then they want to jump in and take over health care, among other things. It is quite a hoot, isn't it?

"Resist, we much. We must, and we much. About that, be committed."

iVillage Member
Registered: 05-13-2009
Mon, 07-04-2011 - 5:49pm
We've been sledding down the "slippery slope" since the beginning of health insurance coverage and even medical care in general. If you were rich and/or well-insured, medical outcomes were always better than the poor, un or underinsured.

Private insurers deny coverage all the time based on corporate profitability, not the health outcomes of the insured. Life time max coverage is the definition of a death sentence imposed by a corporate actuary. But when government entities made the case for cost benefit analysis, it's a death panel?

I guess I have a problem understanding how for profit market-based denial of health care = good business, but government-based denial = death panel.



iVillage Member
Registered: 06-07-2011
Mon, 07-04-2011 - 6:20pm
If people don't like their private coverage they can get other coverage or pay for it themselves.

I am curious as to how you define " death panel ". Because to me it's when somebody else decides your life is no longer worth the cost of the treatment so you are just left to die. By the sounds of a few of the responses on this tread there appears to be a few folks who are ready for the government to start forming them. Because, after all, old people should just not be a burden to the young productive taxpayers and just die already.

How do you define it?
iVillage Member
Registered: 05-13-2009
Mon, 07-04-2011 - 6:50pm




So, private insurance companies get to set limits, but when medicare does it, it's a death panel? What prevents a medicare eligible senior from finding supplemental insurance?

But realistically - How many people can pay oop for health care coverage past 65? Would your father or grandfather pay 93K for a treatment that may buy him 4 to 6 months after a long and hopefully productive life? My 86yo father would not. He loves his medicare coverage and he has a healthy relationship with his mortality.

"Because to me it's when somebody else decides your life is no longer worth the cost of the treatment so you are just left to die."

That sounds like a life time maximum to me that insurance companies use. Provenge and Avastin may be great stepping stones in the search for a cure for cancer or a expensive black hole, but with limited health care dollars dictate that finite resources must be allocated to do the greatest good.

All people (young and old) should get a standard level of care based on the available investment in healthcare.

A death panel, IMO, says that Sen X gets a drug like Provenge, but homeless man Y doesn't because of their perceived value to society. If all have access to the same level of care, there is no death panel. Obviously Sen X could still pay 93K oop, while homeless man Y could not, but both would have access to preventative screenings and early stage care that may circumvent the advanced stage care needs.

iVillage Member
Registered: 06-07-2011
Mon, 07-04-2011 - 8:30pm
You might want to clarify to yourself what "survival advantage" means and understand the statistics before you say it's absurd. It is extremely important to understand statistics and know how to interpret them. I found a helpful article to explain it and will attempt to paste the link, but for some reason, many cannot read my links. If it doesn't work, I would suggest googling what survival advantage means and try to gain an understanding of what statistical numbers actually mean.

http://advancedprostatecancer.net/?p=2171
iVillage Member
Registered: 05-13-2009
Mon, 07-04-2011 - 9:04pm

I can read your link and all I have to say is that's your debate against op? Joel's blog? Really?

I'm sure private insurers equally underwhelmed, but please provide links where "survival advantage" is part of their private health care actuarial science.

There is a finite amount of funds available for insured health care - "survival advantage" should be funded by big pharma, and possibly gov't health subsidies as part of the FDA approval process but not by health insurance, gov't or private until proven as reliable use of the health care dollar. Yes, it

iVillage Member
Registered: 06-07-2011
Mon, 07-04-2011 - 10:20pm
((I can read your link and all I have to say is that's your debate against op? Joel's blog? Really? ))

Wow...no need to be so hostile. I said it was an article to help explain the meaning of survival advantage. I was including this article because to say that the drug will only prevent survival a few months is incorrect.

It is important to have ALL the facts and understand them before you deem a person's life is not worth the cost of treatment.
iVillage Member
Registered: 05-13-2009
Tue, 07-05-2011 - 8:35am
Not hostile - just a little snarky.



Prevent survival, huh? The effectiveness of any treatment is measured statistical analysis which then must be weighed by a cost benefit analysis. In a perfect world we'd all have access to latest and best care that money and science could buy, but the world of medical care is far from perfect and its a damn shame that affordability is determining factor for access to care.

Drugs like Provenge and Avastin have a place in healthcare system, but, IMO, not as a standard course of treatment for all medicare patients with advanced stage cancers.
iVillage Member
Registered: 10-25-2006
Tue, 07-05-2011 - 8:35am

I do understand what "survival advantage" means.

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http://www.pnhp.org/news/2009/october/meet_the_new_health_.php

http://www.youtube.com/watch?v=DQTBYQlQ7yM

iVillage Member
Registered: 06-07-2011
Tue, 07-05-2011 - 8:50am
((Prevent survival, huh? ))

I misspoke. I was typing fast and on my way out the door. I meant to type increase survival.

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