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: 06-07-2011
Tue, 07-05-2011 - 8:59am
((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.))

I don't think anyone is suggesting that these drugs should be used as a standard course of treatment for ALL Medicare patients with advanced stage cancers. However, it appears there Is at least one poster here who thinks it shouldn't be used on any.

Basically, it should be up to the doctor and the patient to determine if the therapy would be beneficial, not some government bureaucrat.

I realize that Medicare doesn't pay for all things. However, if they choose not to pay for this drug for anyone, fine. If there is somebody, who is is not the doctor or patient, deciding if the therapy is worth the cost based on age, productivity to society, etc. then we have just developed death panels. I, for one, don't want the government making my healthcare decisions.
iVillage Member
Registered: 05-13-2009
Tue, 07-05-2011 - 10:42am


I don't want for profit insurance companies making my healthcare decisions either, but they do.

I do want my government to be fiscally responsible with our tax dollars. Not covering procedure x or drug y for anyone based on budget constraints for proven cost effective treatment for all does not remotely resemble a death panel.

iVillage Member
Registered: 06-07-2011
Tue, 07-05-2011 - 11:57am
((I do want my government to be fiscally responsible with our tax dollars. Not covering procedure x or drug y for anyone based on budget constraints for proven cost effective treatment for all does not remotely resemble a death panel.))

You have twisted what I said I consider a death panel. If Medicare will not cover a certain procedure or medication for ANYONE, then fine. But, if the government is going to pick and choose who is and is not worthy of a particular procedure or medication, then that IS a death panel.

iVillage Member
Registered: 10-25-2006
Tue, 07-05-2011 - 12:15pm

<>

If that's how you define 'death panels', then we've had them since the 1950s when insurance companies began making those cost-benefit decisions.

With Provenge we're talking a median survival advantage of 4 months.

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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 - 1:27pm
((With Provenge we're talking a median survival advantage of 4 months.
iVillage Member
Registered: 02-05-2011
Tue, 07-05-2011 - 2:56pm

"

iVillage Member
Registered: 02-05-2011
Tue, 07-05-2011 - 2:59pm

"But, it's also clear to me that a fair amount of progressives are a-okay with letting the old people just die already and don't want them to be a burden to the taxpaying society."

iVillage Member
Registered: 06-07-2011
Tue, 07-05-2011 - 4:08pm
((
iVillage Member
Registered: 11-27-2009
Tue, 07-05-2011 - 4:40pm
That's the exact comparison that frightens me. Where does it end?
Do we stop treating anyone with cancer with a less than 5 year survival rate? Do we stop treated the severely disabled so we can spend the money on a toddler for diapers, milk and day care so its parents don't have too?

iVillage Member
Registered: 10-25-2006
Tue, 07-05-2011 - 6:05pm

<<24.1% reduction in the risk of death>>

What does that mean?

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

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

Pages