A  Tsunami Of Change Is Descending On Myeloma and Cancer – What Is ICER, Medicare Part B Changes, And Monopoly Drug Pricing

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Mark your calendar for May 19th.   Unless you have been living under a rock, you can not help but hear about how some companies have acted irresponsibly and raised drug prices by 5000 percent.  Many cancer drugs cost upwards of $100,000 per year and more, and continue to increase at outrageous rates.   Our government has discussed this but has done nothing to bring these monopolistic pricing practices into check, so Medicare and private insurance companies have looked to reign in these run away drug prices.  Medicare has proposed major changes to Medicare Part B in an attempt to slow the explosion in health care expenditures. Today, Medicare Part B generally pays physicians and hospital outpatient departments the average sales price of a drug, plus a 6 percent add-on. The proposed model would test whether changing the add-on payment to 2.5 percent plus a flat fee payment of $16.80 per drug per day changes prescribing incentives and leads to improved quality and value.  Most of all it would promote the use of cheaper drugs.  

Others would like to have the insurance companies take on the doctors treatment decision process and deny coverage based on a FORMULA. An independent (funded in large part by insurance companies) ICER (Institute for Clinical and Economic Review)  following in footsteps of NICE (the UK’s National Institute for Health and Care Excellence) has looked to develop a formula which will value a year of life at between $50,000 to $100,000.  In addition, they use a gauge of life which devalues a year of a patient’s life  to a fraction of a year  the sicker the patient is.  They actually go negative for someone who is bedridden and can not care for themselves.

This is a very complex subject, and luckily Dr. Rajkumar of Mayo Clinic, a respected and world renowned myeloma specialist, has been kind enough to be part of a Cure Talks broadcast to help to educate the doctors, patients, and the general public on what these program are and how they might affect the doctor patient relationship.  I can tell you that there has been a tidal wave of criticism of the ICER program. One view of the program comes from Dr. Durie, the head of the International Myeloma Foundation.  You can read his evaluation of the ICER program if you CLICK HERE.

The Cure Talks broadcast will be on May 19th at 6:00PM EST.  I will provide the details of the program in a later post.