Medicare agrees to pay $93,000 for prostate cancer treatment drug but not breast cancer drug offering similar benefits to women

Posted on March 31, 2011

Just trying to understand the inconsistency here.

Medicare has stopped covering a late-stage breast cancer treatment drug for women after the FDA claimed the benefits (an extra few months of life in most cases) are outweighed by the risks to the patient. 

When the decision came out, it didn’t fly well with some:

On Dec. 16, the Food and Drug Administration made a decision that could cause thousands of breast cancer patients to lose their last hope. That day, FDA officials voted to revoke approval for Avastin for the treatment of late-stage breast cancer.This move is a disgrace.

Avastin reduces blood flow to tumors, allowing it to halt the spread of breast cancer in some patients. In one clinical trial, 52 percent of Avastin users saw their tumors stop growing or spreading to other parts of their bodies.

In most other breast cancer patients, Avastin acts as a pause button, temporarily sparing women from deteriorating further. On average, Avastin extends life by a few months. However, some “super responders” react especially well and enjoy additional years. (emphasis mine)

FDA bureaucrats know this but ignored the evidence. The FDA stated this month that Avastin does not offer “a sufficient benefit in slowing disease progression to outweigh the significant risk to patients.”

How could the FDA come to such a conclusion? The agency was likely influenced by Avastin’s cost. Medicare, Medicaid, and private insurers typically pick up a substantial slice of the tab for Avastin, and an annual regimen costs upwards of $90,000.

Yesterday, Medicare announced it WOULD be covering a prostate cancer treatment drug that costs $93,000 and extends a man’s life by about the same amount of time Avastin did for breast cancer sufferers:

WASHINGTON – Medicare officials said Wednesday that the program will pay the $93,000 cost of prostate cancer drug Provenge, an innovative therapy that typically gives men suffering from an incurable stage of the disease an extra four months to live. (emphasis mine)

The Centers for Medicare and Medicaid said the biotech drug made by Dendreon Corp. is a “reasonable and necessary” medicine. The decision ensures that millions of men would be able to afford the drug through the government-backed health care coverage. With government reimbursement, analysts estimate Provenge could rack up $1 billion in sales next year. The decision, which will be finalized by June 30, is important for Dendreon because most prostate cancer patients are 65 or older.

Two cancer treatment drugs, both with approximately the same cost and life-extending benefits, yet only one gets covered by Medicare.  What gives?

Posted in: Medicare