Wasting Medicare Money?

Here’s a clever idea for how to save Medicare some cash without hurting patients. Don’t pay for treatments found to be useless.

FLOYD NORRIS

Notions on high and low finance.

The Food and Drug Administration today revoked the approval of the drug Avastin as a treatment for breast cancer, saying, according to the Times article, that “the drug was not helping breast cancer patients to live longer or control their tumors, but did expose them to potentially serious side effects such as severe high blood pressure and hemorrhaging.”

Notions on high and low finance.

The drug remains on the market for other uses, meaning doctors can prescribe it if they wish to do so. The article states it is most likely that private insurers will refuse to cover the $88,000 cost of the drug, but that “Medicare, however, has said it would continue to pay for the drug’s use in breast cancer.”

How can that be?

The article explains:

Medicare is obligated to pay for off-label use of cancer drugs that are listed in references known as compendia, such as the one published by the National Comprehensive Cancer Network, an organization of major cancer hospitals.

In July, shortly after the F.D.A. advisory committee voted to revoke the approval, a committee of breast cancer specialists assembled by the cancer network reaffirmed that Avastin should remain listed as “an appropriate therapeutic option for metastatic breast cancer.”

So a committee that includes doctors who may stand to profit from getting the government to pay for useless medicines — or even have ties to the drug maker — can get to overrule the F.D.A. on how to spend scarce taxpayer money.

Can anyone explain why there should a law requiring that Medicare to pay for off-label uses, other than by referring to the lobbying power of pharmaceutical companies such as Genentech, which makes Avastin?