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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Avatar for claddagh49
iVillage Member
Registered: 07-20-2004
Sun, 07-03-2011 - 6:06pm

Does'nt median mean at least 4 months? What if it was your husband or adult son?

Avatar for claddagh49
iVillage Member
Registered: 07-20-2004
Sun, 07-03-2011 - 6:06pm
iVillage Member
Registered: 03-03-2009
Sun, 07-03-2011 - 10:21pm
Considering the major cost, for relatively minor benefits, it's hard to justify that amount of money. But if the affected person or his/her family wished to pay for it out-of-pocket, they should be allowed to do so.

Jabberwocka

iVillage Member
Registered: 03-02-2009
Sun, 07-03-2011 - 11:27pm

But if the affected person or his/her family wished to pay for it out-of-pocket, they should be allowed to do so.

Really? How benevolent.

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

iVillage Member
Registered: 03-03-2009
Sun, 07-03-2011 - 11:57pm
Are you arguing that taxpayers should foot the bill?

Jabberwocka

iVillage Member
Registered: 03-02-2009
Mon, 07-04-2011 - 12:10am

Is that what democrats want?

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

iVillage Member
Registered: 03-03-2009
Mon, 07-04-2011 - 12:51am
There's a difference between providing health care, for a reasonable cost, in order to have a decent quality of life; and throwing huge sums of money at a condition or disease which is terminal-- for the sake of a very limited extension of life. Moreover, "off-label" use of a drug is often dicey and frequently has more to do with profits for the pharmaceutical company than benefits for patients.

I ask again. Do you propose that taxpayers foot the bill ? BTW, Medicare is NOT a cornucopia of benefits and therapies. There are restrictions. Always have been. So the "promise" word is not without caveats.

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!

Jabberwocka

iVillage Member
Registered: 10-25-2006
Mon, 07-04-2011 - 11:06am

No.

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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: 10-25-2006
Mon, 07-04-2011 - 11:26am

Exactly!

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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
Mon, 07-04-2011 - 12:25pm
Once this slippery slope begins it will be difficult to stop. This will only be the beginning. Once they can say that this treatment is not worth the cost since it seems to only prolong life for an additional 4 months and cut the risk of death by 24% what will the next cut be? If 4 months are not enough to justify the price tag, will 5 months be enough? 12 months? Who is going to decide when it becomes just to expensive to pay for medical care for the sick and it would be better for the rest of us if they just die and not burden the productive members of society with their medical bills?

I guess some are more okay with the beginnings of death panels than they were when Sarah Palin first warned of them.

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