Examiner Editorial: Medicare czar faces life-and-death choices 

Two organizations not known as members of the “vast right-wing conspiracy” are worried that President Barack Obama’s recess-appointed Medicare czar won’t allow the government health care program to cover two Food and Drug Administration-approved anti-cancer drugs with proven records of extending patients’ lives.

The FDA approved Provenge, which is used to fight prostate cancer, and Avastin, which is used to delay the spread of breast cancer after it appears elsewhere in the body. The problem is that Dr. Donald Berwick, the man Obama recess-appointed as administrator of the Centers for Medicare and Medicaid, appears to be considering denying Medicare reimbursement for patients using Provenge and Avastin.

The Ovarian Cancer National Alliance explained the problem: “Medicare must cover therapies that are ‘reasonable and necessary,’ while the FDA is instructed to approve drugs that are ‘safe and effective.’ Because of the conflicting federal coverage and approval requirements, there are some non-FDA-approved drugs (called off-label drugs) that are paid for by [the Centers for Medicare and Medicaid]. However, with respect to Provenge, it appears that [the Centers for Medicare and Medicaid] is arguing that while the treatment is safe and effective, it may not be reasonable and necessary. For the first time, an FDA-approved anti-cancer therapy may not be covered by Medicare.”

The same problem has developed with Avastin, according to Susan G. Komen for the Cure, which has joined with the Ovarian Cancer National Alliance advocating for Medicare coverage of both drugs. With respect to Avastin, Komen’s founder and CEO, Ambassador Nancy Brinker, said, “We recognize the benefits of Avastin overall are modest for women with metastatic breast cancer. However, we do know that for some women, Avastin offers a greater than modest benefit.”

Brinker added that “the decision to use Avastin should be made between a woman and her doctor after a thoughtful conversation that carefully considers the drug’s benefits and risks. Komen does not want to see access limited by Medicare and Medicaid.”

Berwick has been on the job barely a month, but already he faces momentous life-and-death medical-coverage decisions that Obamacare critics said were inevitable and would smack of death-panel-like deliberations. This is the same Berwick who said in 2009 that “the decision is not whether or not we will ration health care. The decision is whether we will do it with our eyes open.”

There are cost considerations with both Provenge and Avastin, with the former estimated to cost $23,000 per added month of life and the latter being effective with some women suffering from an advanced stage of breast cancer, but not with others.

Will Berwick give a few extra months of living to cancer sufferers or let them die sooner in order to save a few bucks for the government?

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Staff Report

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A daily newspaper covering San Francisco, San Mateo County and serving Alameda, Marin and Santa Clara counties.
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