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Radioimmunotherapy Reimbursement Cuts

Date: August 31, 2007

By P. C. Venkat

An Important and Effective Therapy Option May Disappear

Related Article:
Bexxar: An Introduction to Radioimmunotherapy

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The following alert from Karl Schwartz, President of Patients Against Lymphoma, a non-profit patient support group, highlights an issue that will likely change the availability of an entire treatment modality for hematological malignancies. Radioimmunotherapy, while classically not considered CLL treatment, nevertheless can be an effective and low-toxicity approach to producing clean, durable remissions after induction therapy to reduce bone-marrow involvement (see Bexxar: An Introduction to Radioimmunotherapy). As part of the affected patient population, we request that you take a minute to read Karl's Alert below. He explains the issue clearly. As to what you can do about it: we hope you agree with the approach taken by PAL and complete and submit the endorsement form attached to his Alert below. Keep in mind that officially CLL/SLL are a subset of the range of lymphomas. We have the greatest respect for Karl Schwartz and his group and applaud his initiative to make our voices heard.

In our opinion, this is a clear case of an existing valid and valuable therapy option that needs further development for use in CLL as opposed to being rendered non-viable by reimbursement economics.

PAL Alert

Dear friends and collegues,

Please take a few minutes to review our letter to Centers for Medicare and Medicaid Services (CMS) in order to address a a policy matter of great concern to patients with lymphomas ... and other cancers, present and future.

~ Karl Schwartz

Patients Against Lymphoma

Condensed version:

Patients Against Lymphoma is a non-profit organization, independent of health industry funding. In this letter we are representing the concerns of many lymphoma survivors and their loved ones regarding proposed CMS payment policies for radioimmunotherapy (RIT) agents (Bexxar and Zevalin), administration, and supply.[i][i]

As shown in the enclosed chart [ii][ii], the proposed reimbursement for Bexxar (I131Tositumomab) is regrettably less than half its cost, which causes hospitals to lose money, which if approved would force hospitals to subsidize its use, which is highly unlikely.

These are our main concerns about proposed reimbursement rates for RIT for patients with life-threatening lymphomas:

We agree with Dr. Mark Kaminski, [2][2] a principal inventor of radioimmunotherapy, that the low payment policies for RIT will have a “devastating” effect on lymphoma patients living with the disease today, on future patients, and on cancer research in general – creating a domino effect[v][v] described in the appendix. .... (see links to full text for detail)

In closing, we cannot afford to ignore these issues or to be silent. Underpaying hospitals for costs of providing radioimmunotherapy is already having a negative impact on the level of care for patients with lymphoma, who now have an improving hope of conquering or better managing the disease and living normal, productive lives. We, as well as the undersigned who share their concerns in the attachments to this letter, urge CMS to fully reimburse for the use of Bexxar and Zevalin.

We also urge CMS, the medical community, advocates, and our elected representatives, to work cooperatively in order to fully fund CMS and identify responsible ways to reduce health care costs in order to meet the urgent needs of cancer patients, present and future. Thank you for your attention to our concerns.

Full text:

Letter to CMS as a PDF
Letter to CMS as a Web Page
Form to Add Your Endorsement

Action Needed

Please do take the time to read these documents and if you agree, add your voice to the viewpoint expressed.




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