Is Medicare Penny Wise and Pound Foolish?

The recent news about Medicare cuts for the radioimmunotherapy (RIT) agents I-131 Bexxar and Y-90 Zevalin reminded me of the English proverb about being penny wise and pound (dollar) foolish. The latest report on this was published on the website of the Boston Globe. 

This report noted that Medicare was proposing to only reimburse $16,000 for the radioisotopes, while the price most hospitals pay ranges from highly subsidized to a more standard cost between $25,000 to $30,000. By factoring in the highly subsidized use, the cost figures Medicare used to calculate the reimbursement becomes inaccurate and may result in patients being unable to get this treatment; particularly since, under Federal rules, hospitals who do not offer a drug to Medicare patients are prohibited from providing these same drugs to patients with other insurers.

For some relapsed non-Hodgkins lymphoma (NHL) patients, the RIT agents may be the only therapy choice left. Even for those who can try other chemotherapy or naked (non-radiolabeled)  immunotherapy routines, the article indicates that therapy costs can run to about $50,000 a year. So, does it make any sense to save money by reducing the cost of RIT, only to spend a higher amount having the patient take a different therapy that may not work as well as RIT?

Even more disturbing is what this says to any manufacturer thinking about investing in research for a radioimmunotherapy, especially since these two therapy agents, while showing excellent results, have not seen rapid acceptance by the medical oncologists treating NHL patients.

Are you offering RIT with one of these agents? Do you feel your oncologists are sufficiently educated on their advantages? Is your facility rethinking use of these molecular therapy agents because of reimbursements issues? Let me know what you think about how this will affect the future of RIT.