Medicare Regulation Causes Shortages of Cancer Drugs
Close By Aug 9 2011, 11:58 AM ET Comment For months, I've been hearing about shortages of drugs--ADHD drugs, cancer drugs, various other generics.
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Since: Dec 05
#1 Aug 11, 2011
The new Medicare (MMA) bill tried to curtail the chemotherapy concession, which was a shameless way to preserve a system which presented an impossible conflict of interest for both cancer centers and treating oncologists.
It was a system of financial incentive to choose certain forms of chemotherapy over certain others and to administer infusion chemotherapy as opposed to providing other forms of patient care.
The Jacobson, et al, Michigan/Harvard study showed results before the new Medicare reform, while Neil Love's "Patterns of Care" study showed results that the Medicare reforms were still not working.
The "Patterns of Care" study showed academic center-based oncologists (who do not derive personal profit from infusion chemotherapy) prescribed lower-priced drugs, and none of them prescribed the expensive, highly remunerative drugs. In contrast, the community-based oncologists (who do derive personal profit from infusion chemotherapy), prescribed the expensive, highly remunerative drugs.
Then another Jacobson study in 2010, examined the impact that Medicare payment cuts for chemotherapy drugs had on treatment for Medicare beneficiaries with cancer, before and after implementation of the new payment system. Contrary to concerns about access, they found the changes actually increased the likelihood that cancer patients received chemotherapy.
I believe these studies showed results that the Medicare reforms are still not working. An impossible conflict of interest still exists. And the existence of this profit motive in drug selection has been one of the major factors working against the individualization of cancer chemotherapy based on testing the cancer biology.
Over the last 20 years, there has been a lot per capita abuse of chemotherapy, in terms of cost benefit ratio to the system and toxicity benefit ratio to the patient. It's going to be up to us to make a difference by speaking out, in fixing those aspects of all of this which have gotten broken along the way.
I think the key is to begin to pay oncologists (and other specialists) more for talking to and listening to patients - and less for very expensive, very aggressive treatments. Medical oncologists should be taken out of the retail pharmacy business and forced them to be doctors again.
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