JustCare

Tag: Chemotherapy

  • Medicare encourages doctors to use costliest cancer drugs 

    Medicare encourages doctors to use costliest cancer drugs 

    The Trump Administration has identified one problem with Medicare payment rates for drugs. StatNews reports that CMS Chief Seema Verma critiqued Medicare regulations that encourage doctors to use the costliest cancer drugs as well as incentivize pharmaceutical companies to charge a high price for cancer drugs.

    You can be sure that pharmaceutical companies give doctors a strong financial incentive to use their most costly cancer therapies. In exchange, Pharma may pay for their vacations, dinners and speaking fees. But, Medicare gives doctors a second incentive to prescribe the highest-cost cancer drugs. It pays them more to use them.

    Medicare pays doctors for the cost of chemotherapy drugs plus six percent for administering these drugs. The higher the cost of the drug, the more the doctors earn.  It should go without saying that ease of administration has nothing to do with the amount Medicare pays doctors.

    Why would Medicare pay a doctor $6,000 to administer a $100,000 drug therapy, much less $30,000 to administer a $500,000 drug therapy. Why would Medicare pay different amounts for the same drug therapy depending upon whether it is administered in a hospital or an outpatient clinic? It is all about the influence of the pharmaceutical companies and big Pharma.

    In a recent speech, CMS chief Seema Verma posed these questions and critiqued Pharmacy Benefit Managers (PBMs) for having a conflict of interest. They allegedly negotiate lower drug prices for insurers. But, they also pocket money from the drug manufacturers to promote their costly drugs. According to Verma, they may keep some of the drug discounts they achieve for themselves.

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  • New cancer drugs cause serious side effects

    New cancer drugs cause serious side effects

    Laurie McGinley at the Washington Post reports on new cancer drugs–checkpoint inhibitors–that cause serious side effects. These therapies treat people with advanced melanoma and complex bladder, kidney and lung cancers. But doctors are not always aware of the side effects, which may need to be addressed immediately to protect a patient’s health.

    One new cancer treatment put a 55-year old woman’s cancer in remission. At the same time, the cancer treatment caused Diane Legg to start seeing black specks in both eyes. She was misdiagnosed as having a torn retina requiring laser surgery, when in fact she had uveitis, inflammation of the eye. The misdiagnosis delayed her treatment for the inflammation. And, perhaps because of the delay, she continues to see specks.

    Different immunotherapy treatments using checkpoint inhibitors have different side effects. But, with some immunotherapies, as many as seven out of 10 patients may experience side effects. They can be minor rashes, to diabetes, to grave heart conditions. Legg’s cancer treatment caused her to get arthritis, lung inflammation, pneumonitis and liver inflammation, in addition to the uveitis.

    The side effects from an immunotherapy can present like the flu or food poisoning and get mistreated. Doctors need to know that and be prepared. Immunotherapy patients, in turn, need to be aware of the difference between immunotherapy and chemotherapy because they have different side effects. Any new doctors they see following their immunotherapy treatments need to understand they are immunotherapy patients in order to treat them appropriately. And, patients need to report what they might believe to be minor side effects as soon as possible to their doctors.

    Most doctors believe that treating the cancer through immunotherapy is worth the side effects because the cancer is life-threatening, unlike most side effects. And, on the face of the evidence to date, that makes sense. But, these are early days. Over time, there will be more data on the risks of harm as compared to the likelihood of benefit from immunotherapies.

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  • Unlike Canadians, Americans pay a huge financial and emotional price for health care

    Unlike Canadians, Americans pay a huge financial and emotional price for health care

    Catherine Gordon reports for the UC Observer on cancer care in Canada and the US, profiling her own experience in Canada and that of her sister Karen, in the US.  The sisters were diagnosed with breast cancer within one year of each other. They both received first-rate treatment; but, unlike Catherine, Karen paid a huge financial and emotional price for her health care.

    Both sisters had six chemotherapy treatments and 25 rounds of radiation treatment. Catherine’s medical bills were minimal, $750 in out-of-pocket costs and $1,200 for her wig. The Ontario Health Insurance Plan paid for the rest of her care. Ontario’s Assistive Devices Program paid for most of the cost of her $400 breast prosthetic.

    Karen, in sharp contrast, paid more than $23,000 out of pocket–about $7,500 in health insurance premiums and $16,000 to meet her deductibles over her two years of care. In addition, she suffered through the emotional and financial hassles of deductibles and copays, as well as accessing needed care. Karen was asked to write a check for her care minutes before she was about to get surgery. “Just as I was getting ready to head to the operating room, a tall man in a nice suit came in and told us he had to have a cheque before they would go ahead. ‘It’s our new policy because people aren’t paying their bills.’  We paid him, of course, but it seemed absolutely outrageous — especially when you’re frightened and sick.”

    Catherine reports that Karen’s file folder of  medical bills was three inches thick. She had nearly 50 bills from a range of health care providers, including pathologists, imaging centers, radiologists, plastic surgeons, anesthesia services, blood labs. She had no clue who many of these providers were or what services they had provided. Karen had to navigate this sea of bills, while “in crisis mode and trying to deal with getting well.”

    Watch this video put together by Bernie Sanders to learn more about Catherine and Karen’s experiences getting cancer care in Canada and the US, respectively.

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