Portal de Periódicos da CAPES

Pressure Mounting for Medicare Coverage of Oral Chemotherapy Drugs

2002; Wolters Kluwer; Volume: 24; Issue: 5 Linguagem: Inglês

10.1097/01.cot.0000285925.97067.64

1548-4688

Peggy Eastman,

Chemotherapy-related skin toxicity

WASHINGTON, DC—Legislators, cancer advocates, and cancer patients gathered at a news briefing sponsored by the National Coalition for Cancer Survivorship (NCCS) on Capitol Hill to press for passage of bills that would extend Medicare coverage to all approved oral anti-cancer therapies, even those that have no injectable equivalent. Under current Medicare policy, the program pays for cancer therapies in pill form only if they also have an intravenous form. “There is overwhelming support for doing this coverage now,” said NCCS President and Chief Executive Officer Ellen Stovall, a 30-year cancer survivor and a member of OT's Editorial Board. She said an NCCS-commissioned Harris poll of 1,007 Americans showed that the vast majority of respondents—89 percent—support changing Medicare policy to cover oral chemotherapy drugs that have no injectable equivalents. Many of the important chemotherapy agents that are going to be produced in the near future are going to be oral drugs, said Larry Norton, MD, 2001–2002 President of the American Society of Clinical Oncology. He said it “makes no sense” to be able to develop cutting-edge drugs based on the latest scientific discoveries if all Americans cannot have access to them. Since older people are statistically more likely to develop cancer, the access issue is an especially crucial one for Medicare beneficiaries. According to NCCS data, half of all cancers are diagnosed in people aged 65 and over, and of the estimated 41.5 million Medicare beneficiaries today, more than 20 percent—8.3 million Americans—have at least one diagnosis of cancer.Figure: NCCS President and CEO Ellen Stovall presenting the results of a Harris poll showing that 88% of Americans believe that Medicare should pay for all medically approved cancer therapies. Of the remainder, 5% did not support such a change and 7% said they were not sure.‘Playing Catch-up’ “Obviously the Medicare program has to play serious catch-up,” said Senator Olympia Snowe (R-ME), cosponsor of the Access to Cancer Therapies Act (S. 913), which would ensure Medicare coverage of approved oral anti-cancer therapies. “If it doesn't, we'll have a two-tiered system”—those who can pay out of pocket for oral anti-cancer drugs and those who cannot. She added, “Less means should not mean lesser care.” Senator Snowe said she and her Congressional colleagues don't want to see a repeat of the situation with imatinib (Gleevec), which is not covered by Medicare. Senator Snowe said that of 40 oral anti-cancer drugs on the market today, fewer than 10 are reimbursed by Medicare, including tamoxifen. She said that in the foreseeable future as many as 25 percent of anti-cancer drugs will be oral, and those new therapies would be omitted from Medicare coverage unless the program's current payment policy for oral drugs is changed. Today, oral chemotherapy drugs represent about five percent of the oncology market. “If we had a [Medicare] prescription drug benefit, we wouldn't have to be having this conversation,” said Senator John D. (Jay) Rockeller IV (D-WV), the other cosponsor of S. 913. “But you can't just stop the world in the meantime…not everybody can wait.” Of the current Medicare rule on oral chemotherapy drugs, he said, “It's just not good public policy. It makes no sense.…This is a matter of life and death. Let's make this act happen.” Senator Rockefeller noted that oral anti-cancer therapies are frequently the most popular and least toxic treatments, and they are practical for people in rural states like his who do not have ready access to physicians and hospitals. He said Congress can work simultaneously on legislation that would expand Medicare coverage to oral chemotherapy agents and legislation that would grant seniors a comprehensive Medicare drug benefit. He estimated that the oral anti-cancer drug benefit would cost Medicare $2.8 billion over a period of years, whose number is yet to be determined. Remarks by Patients “It seems to me this would be cost-effective,” said Anita Johnston of New York City, an 11-year survivor of non-small cell lung cancer. She takes the oral investigational growth-factor signaling inhibitor Iressa, which she said is as easy as taking her vitamin pill. “I have been on—you name it—every type of protocol,” she said. “This is a wonderful drug.” She said she believes the Medicare access issue is critical, and added, “I don't think that people should be expendable just because they're older.”Figure: Senators Olympia Snowe (R-ME) and John D. (Jay) Rockefeller IV (D-WV) are cosponsors of the Access to Cancer Therapies Act (S. 913), which would ensure Medicare coverage of approved oral anti-cancer therapies.Another speaker, Kenneth Regan of Grand Rapids, MI, said he has been battling multiple myeloma for eight years, and two years ago he found an oral treatment that has changed his life—the anti-angiogenesis agent thalidomide. “The quality of life of the patient improves,” he said. “With oral drugs, you eliminate the go-between man and do not have to receive treatment in a doctor's office or hospital.” Mr. Regan's wife, Mary, a hospice nurse, confirmed that oral anti-cancer drugs can be a boon, but said she knows of many patients who cannot afford to pay for them out of pocket. “I'm one of the lucky ones,” said John Rowe, a staff member of the Committee on Government Reform of the US House of Representatives, who takes Gleevec. “The side effects are so trivial they're not worth mentioning.” He said that in his view the US Congress owes it to the generation that fought in World War II to make the change in Medicare policy that is denying them covered oral anti-cancer therapies. “I knew that I had no choice but to pay more than $100 a month” to have access to tamoxifen, said breast cancer survivor and National Breast Cancer Coalition advocate Betty Rea of McLean, VA. “I have been lucky enough to be able to buy it in spite of its cost. But others are not so lucky.” She said she finds it inconceivable that Medicare would pay for treatment administered in the hospital, but would not pay for a potentially more effective, more convenient breast cancer treatment in the form of a pill. House Bill HR 1624 The Snowe-Rockefeller Senate bill has a House version, HR 1624. “This bill not only ensures that seniors will benefit from cutting-edge medicine, but that their quality of life is enhanced,” said lead House sponsor Representative Deborah Pryce (R-OH), Co-Chair of the House Cancer Caucus. “Medicare must keep pace with pharmaceutical research and development.” Howard Bedlin, Vice President for Public Policy and Advocacy of the National Council on the Aging (NCOA), said the 46-member Leadership Council of Aging Organizations, of which NCOA is a member, recently sent Congress a letter on the budget that included support for expanding Medicare coverage to oral chemotherapy drugs. “The number one legislative priority for America's seniors is Medicare prescription drug coverage, and we hope that Congress will soon pass a comprehensive bill,” he said. “However, the Access to Cancer Therapies Act needs to be enacted this year, regardless of whether an agreement can be reached on a larger bill.” The American Cancer Society praised the Senate and House versions of the Access to Cancer Therapies Act. “By covering all oral anti-cancer drugs, the act provides a much-needed update to the Medicare program,” the statement said. Among other organizations supporting the Access to Cancer Therapies Act are the Leukemia & Lymphoma Society— which provided funds for early investigational work on Gleevec—and the National Patient Advocate Foundation.