Physicians

PHARMA/PHYSICIANS: Reimbursements Sway Oncologists’ Drug Choices, by Greg Pawelski

Greg Pawelski is not exactly surprised about the latest revelations about oncologists and their use of chemotherapy.

A joint Michigan/Harvard study confirms that medical oncologists choose cancer chemotherapy based on how much money the chemotherapy earns the medical oncologist. Just published in the journal Health Affairs is a joint Harvard/Michigan study entitled “Does reimbursement influence chemotherapy treatment for cancer patients?” In a study of 9,357 patients, the authors documented a clear association between reimbursement to the oncologists for the chemotherapy of breast, lung, and colorectal cancer and the regimens which the oncologists selected for the patients. In other words, oncologists tended to base their treatment decisions on which regimen provided the greatest financial remuneration to the oncologist  This study adds to the ‘smoking gun’ study of Dr. Neil Love on the subject. The results of his survey show that for first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists prescribed an oral dose drug (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug docetaxel. In contrast, among the community-based oncologists, only 18% prescribed the oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29% prescribed the expensive, highly remunerative drug docetaxel. 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. Once a decision to give chemo is taken, physicians receiving more-generous Medicare reimbursements used more-costly treatment regimens.

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Greg PawelskiWELRenee Killiandrug counselormed student Recent comment authors
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Greg Pawelski
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Greg Pawelski

In randomized clinical trials of breast and colorectal cancer, new effective adjuvant treatments show decreasing absolute benefit, while new treatments of metastatic disease show unchanging levels of benefit at rapidly escalating costs.
The current research and treatment model makes no difference in outcomes, but adds a lot of profit to researchers, oncologists and pharmaceuticals. How about targeting “individuals” with “individualized” therapy?
From Annals of Oncology
http://www.medscape.com/viewarticle/726663?src=emailthis

WEL
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WEL

MAXIDEX WARNING
I had eye surgery and in the p[ost-op pack was MAXIDEX(dexamethasone) drops by Alcon Labs.
Two days later I was BLIND
USE EPOCRATES.COM TO VERIFY

Gregory D. Pawelski
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Gregory D. Pawelski

To address one of the comments above, a recent NYT expose found that Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors’ purchase price. And then get… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

F.D.A. Warning Is Issued On Anemia Drugs’ Overuse Superficially, it sounds like a great expose, greedy clinics/doctors trying to make money by pushing drugs. The New York Times article states that the drugs, given by injection, have been heavily advertised, and there is evidence that they have been overused, in part because oncologists can make money by using more of the drug. That’s not really a new revelation. We’ve been down that road before without much done to change it. According to Dr. John Glaspy, director of UCLA’s Outpatient Oncology Clinic, one complicating factor, experts say, is that oncologists make… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

A National Coalition for Cancer Survivorship (NCCS) poll found that 89% of Americans said that the distinction between oral and intravenous applications should be abolished so that Medicare beneficiaries can have access to the best drugs to treat their form of cancer. Apparently, Medicare has gone far in accomplishing that task. Nearly all generic cancer drugs and 70% of brand-name cancer drugs are covered by the Part D plans. Most of the brand-name drugs not covered had generic equivalents that are covered. And a number of trusted, old (generic) agents have been found to be just as effacious as the… Read more »

Renee Killian
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Many physician offices are refusing to give chemo treatments in their offices now, but are fast to pass them on to the hospital. They are losing $ by administering it in the office, but by sending them to the hospital’s IV clinic the patient will pay more out of their pocket. Good for the hospital and doctor’s office, but not the patient. I have seen patient’s turn down treatment because they do not want to pay the higher cost share at the hospital clinic. That is not good for anyone.

drug counselor
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I think that it’s at least cruel to make those statements.

Gregory D. Pawelski
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Gregory D. Pawelski

M.D. Anderson Cancer Center is taking a new look at how to evaluate new medicines and treatments for cancer. “We need to rethink how we design and conduct clinical trials in the U.S.” says Dr. Donald Berry, one of its scientists. He feels that we should turn the ‘statistical method’ used to evaluate new drugs on its head, stating that it limits innovation and learning. What he’s talking about is the adoption of the Bayesian method of science because it is more in line with how science works. They are putting this approach to the test with more than 100… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

The last time Congress helped “cancer” doctors, Committee Chairman Senator Chuck Grassley (R-IA) found out that the value of the approximately $300 million-a-year demonstration project for oncology to report on a cancer patient’s level of nausea, vomiting, pain and fatigue was for nothing. Providers were being paid an additional $130 per infusional-chemotherapy recipient per treatment day to simply forward data that had already been collected. This year, Congress is being hoodwinked into some other financial incentive to reimburse oncologists that report whether their treatment adheres to practice guidelines published by either NCCN or ASCO. As the “Patterns of Care” study… Read more »

med student
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med student

I wasnt aware that reimbursement changes depending on route of administration.
Do primary care doctors get paid more for adminstering sumatriptan for migraines in injectable, rather than pill form? Thats news to me.

Gregory D. Pawelski
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Gregory D. Pawelski

At a symposium, the speaker, one of the most renowned neuro-oncologists in the world, was asked what the difference was between two drugs (ccnu vs bcnu). His response was “one is oral, one is IV. The only reason to use the IV version is the doctor can charge to administer it.” CMS appeased ASCO-influenced physicians last year by giving them an additional $130 per infusional-chemotherapy recipient per treatment day in return for submitting information about the patient’s level of nausea, pain and fatigue. Senate Committee Chairman, Chuck Grassley (R-IA) had found out that the value of that approximately $300 million-a-year… Read more »

Harvey
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What does the literature say about the relative outcomes of the various treatments in question?
Are the choices of either group putting patients at risk?
Harvey

Gregory D. Pawelski
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Gregory D. Pawelski

The ASCO President says that we go by the literature, which has defined which are the best regimens. Well, how does he explain why the academics prescribe oral dose Xeloda to their metastatic breast cancer patients who aren’t on their protocols, which keeps them from clogging up their chemo rooms and resources, which they want to use for the patients on their clinical trials, while the community oncologists almost universally prescribe infusion therapy, with the most popular drug being the still on patent Taxotere (docetaxel), which I do surmise has one of the best “spreads” between acquisition costs and average… Read more »

Roy M. Poses MD
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