graphic from American Digest
When Barbara’s lung cancer reappeared during the spring of 2008 her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy. However, Oregon’s state run health plan denied the potentially life altering drug because they did not feel it was "cost-effective." Instead, the State plan offered to pay for either hospice care or physician-assisted suicide.
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The answer is simple. Oregon state officials controlled the process of healthcare decision-making—not Barbara and her physician. Chemotherapy would cost the state $4,000 every month she remained alive; the drugs for physician-assisted suicide held a one-time expense of less than $100. Barbara’s treatment plan boiled down to accounting. To cover chemotherapy state policy demanded a five percent patient survival rate at five years. As a new drug, Tarceva did not meet this dispassionate criterion. To Oregon, Barbara was no longer a patient; she had become a "negative economic unit."
Physicians for Reform want you to know What This Means for You
This is one great worry I have with the current health reform debated nationwide. I have been on Tarceva for almost 4 years and have survived lung cancer over 5 years. Tarceva is a new biotech targeted therapy chemo drug which was approved by FDA to treat non-small cell lung cancer with excellent results for 5-10% lung cancer patients. I am one of the lucky ones that my prescription insurance company still covers this expensive chemo drug with $75 monthly co-payment which is affordable. Our Medicare covered all hospital chemo treatment, but not the chemo drug you are able to take orally at home. I believe the reform should update the coverage to cover the new treatments for cancers whether it is provided in a hospital setting or patient managed treatment at home. With the government operated insurance, I am afraid my private provider will find the excuse to start eliminate these expensive drugs like what Oregon has done.
Posted by: Lily Wai at August 7, 2009 2:16 PM