Pebble Beach, CA Insurance Companies, Medicare and Medi-Cal Debate How To Reimburse For Expensive Cancer Drugsby Richard Kuehn on 10/04/12
Medical decisions are being increasingly taken out of the hands of physicians and their patients as private insurance companies, Medicare and Medi-Cal debate what drugs and procedures should be covered, and for how long they want to reimburse for them. This is extremely difficult if you are trying to get an experimental drug for cancer or some other potentially fatal ailment, and your insurance company refuses to pay for it. One argument was resolved this week when two studies found that the best time period for taking the expensive breast cancer drug Herceptin was optimal. One study showed that extending treatment to two years shows no increased benefit, while another found that shortening it to six months results in a worst outcome for cancer patients. The drug has been controversial because it costs $54,000 per patient for year. It generated $5.6 billion in worldwide sales for Roche Holdings last year, which paid for one of the studies. I think the studies are worthwhile, but I hope that the future of our health depends on the decisions that physicians make in tandem with their patients. I would hate to have some potentially fatal ailment and find a treatment was available for it but that I couldn't afford it.