January 1 Looms Large For Lymphoma Patients

Armen Hareyan's picture
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Lymphoma

The Leukemia & Lymphoma Society is urging the U.S. Department of Health and Human Services (HHS) to reverse detrimental changes to reimbursement rates for two lymphoma drugs. If the HHS does not act, the changes would severely limit the availability of the two therapies, which for thousands of non-Hodgkin lymphoma (NHL) patients represent their best or only resort for effective treatment.

The Centers for Medicare and Medicaid Services (CMS), an HHS division, has set reimbursement levels for these drugs, effective Jan. 1, which will create unreasonable obstacles to accessing these lifesaving therapies.

The drugs in jeopardy are two radioimmunotherapies -- Bexxar and Zevalin -- which are both critically important treatment options for patients with NHL. The drugs work by delivering a radioactive isotope to the cancer cells. CMS has established reimbursement levels for the 2008 hospital outpatient prospective payment system, which will result in less than 50 percent coverage for Bexxar and Zevalin. Hospitals will not be able to cover the other half of these costly drugs, thereby effectively eliminating access to these treatments.

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The Society urges the following steps be taken immediately:

-- CMS should classify the radioimmunotherapy regimen a specified covered patient drug. The Society believes that the CMS improperly considers the initial doses of radioimmunotherapies to be diagnostic rather than therapeutic doses. This is not consistent with U.S. Food and Drug Administration labeling or with current practice.

-- CMS should cover the cost of compounding radioimmunotherapies. Institutions should be paid fairly for the costs associated with compounding these products.

-- The agency should consider setting payment for radioimmunotherapies on the basis of 106 percent of average sales price or a composite ambulatory payment classification that would reflect the entire costs of the radioimmunotherapy regimen.

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