So the fight over cancer drug reimbursement is getting quite nasty. The doctors, who as we’ve explained in TCHB many times, have done very well over the last decade or so by dispensing drugs and charging Medicare and private payers a whopping margin, are crying foul as the details of the current price cutting by CMS emerge. Apparently they believe that the overall cut will be 15% as opposed to CMS’s stated 8%. There’s much more in this AP Article.
There’s actually some real money at stake here. About $600m is being cut from the chemo drug budget. ASCO claims 20,000 members but my mole in the business tells me that there are somewhere around 10,000 oncologists (or docs dispensing enough chemo to be counted as oncologists) in the US with an average income in the high-$300,000s of which roughly half comes from the drug mark-up. So you could argue that actually 30% of the doctors’ drug income (i.e. their margins rather than total drug spending) or around $60,000 per physician, is on the table. So expect the fight to continue, and of course have ramifications downstream on the pharma companies, and upstream on the patients.
I fought for chemo-sensitivity testing of cancers over 20 years ago, and finally lost because of the problems with the tests. First, it’s often hard to get a representative sample of tumor cells by biopsy. Then it’s hard to get them to grow. Then you’re not sure whether the cells that grew out are the tumor cells, or normal matrix, like fibroblasts. Then there’s the delay in starting treatment while waiting for the cells to grow out. Then there’s the question of whether cells in metastases have the same response as those in the primary. But the killer was that the clinical response was not that well predicted by the cell survival tests in the lab. And of course, there was the expense.
Unless there has been some major advance in the intervening years, I can understand the reluctance of some oncologists to go back to it. Alternatives to growing the cells and seeing what kills them may now exist, but they are only surrogates for the real end-point of interest.
Sidebar: I was struck by an amusing wrinkle in the end of the chemo article which showed how close the two sides are politically, even if they are fighting over money:
Ketchum Communications, the public relations company working with the cancer doctors to call for a change in the Medicare law, also is the principal contractor employed by the administration to promote that same law. The administration has spent $87 million on television ads, mailings and other means to promote the new law, most of it to tout prescription drug coverage that will be available through Medicare in 2006, the Health and Human Services Department said.