Medicare Expansion Creates Conflict In Medical Practitioners

This expansion was created to help cancer patients receive “off-label” treatments; a change which cancer doctors were vocal in supporting for many years. Many doctors claim that the change was necessary to allow patients to receive the most up-to-date treatment available.

On the other hand critics say that the change leaves patients open to abuse because the compendia or guides that decide coverage could now be more easily influenced by their ties to the drug companies. Also the new system may expose patients to ineffective treatments and in turn potentially harmful side-effects.

In an interview granted to the Wall Street Journal; Thomas Kaye, the pharmacy director at a Kentucky insurance plan that processes claims for Medicare, said he expects payments for cancer drugs to rise under the new system. Mr. Kaye said the new system is "biased toward the compendia and influence from drug makers." He and others note that two of the compendia are funded, in part, by pharmaceutical concerns and a third uses reviewers with financial relationships to drug makers.

Another interview granted by Dr. Allan M. Korn, the chief medical officer for the Blue Cross and Blue Shield Association, to the New York Times states that: “We have very little faith that those indications that make it into the compendia are safe, let alone effective,” the doctor then added that Medicare should cover off-label drugs only if the results of their use are carefully tracked afterward. There is no such requirement in the new Medicare guidelines.

Still, it is almost universally recognized that the old system was too slow in recognizing newer treatments. Many medical practitioners are simply looking at these treatments as a last resort; to be used only when all other options have been exhausted and the cancer has reached an advanced stage of development.

By: Alberto Ramos Cordero