How Washington Is Nixing a Cancer Cure

CMS, the most powerful federal agency you've never heard of, has total authority over which treatments Medicare and Medicaid will cover. Smelling weakness in the RIT market, it announced in August that it will reimburse hospitals less than 50 percent for Bexxar and Zevalin. Because hospitals can't be expected to pick up the other half (the drugs cost more than $25,000), this will mean the effective end of these life-saving treatments.

Even if a wealthy individual wants to pay out of pocket for RIT, it won't be available, because CMS says it will "terminate the provider agreement of any hospital" that administers the treatment to some patients but not to "Medicare patients who need it."

The absurdity of this defies belief. Here's the government acknowledging that many cancer patients "need" the treatment, but warning that if hospitals offer it, they will "terminate" their indispensable Medicare funding for the hospital!

CMS's excuse is that RIT is partly "diagnostic," which means, under complex funding formulas, that it is due less reimbursement. This is nonsense. As GlaxoSmithKline, maker of Bexxar, explained at length to CMS, the treatment is clearly therapeutic. The 1,500 patients and patient advocates who have contacted CMS to complain about the new policy agree.

Lest you think only drug companies and patients are up in arms about this, listen to Dr. Andrew Schafer, who is president of the American Society of Hematology, the most prestigious professional organization in blood cancer: "It [this ruling] will eliminate one of the few treatment options and perhaps the only treatment option for some patients with non-Hodgkins lymphoma who have failed chemotherapy treatment."

In other words, the patients die.