Wednesday, May 30, 2007

A Losing Proposition

Got Medicare?

Need drugs?

Think again.

Mattioli's doctor is one of thousands of small practitioners who are getting out of the business of administering drugs for conditions ranging from anemia and cancer to arthritis and infections, forcing hundreds of thousands of patients to get the drugs elsewhere. It is an unintended consequence of a change in the way Medicare reimburses doctors for a class of drugs that are most often injected or infused.


The taxpayer funded, government health care program that is the only option for our senior citizens.

The change is hurting small medical practices in particular because most of them don't buy enough of any one drug to get the big rebates or discounts that drug companies offer to large customers. Making matters worse, Medicare now reimburses doctors based on a drug's average sales price, and the big rebates to large customers have driven down Medicare reimbursements especially for expensive anti-anemia drugs

So where does one go for these meds? Wal-Mart?

Edward Ambinder, one of two doctors in a New York oncology practice, said he loses money on anti-anemia drugs. He pays $528 for one 40,000-unit dose of Procrit, he said, and Medicare reimburses him only $378.

Losing $150 on each patient.

This can't be good.

Doctors who buy their drugs in higher volumes can still afford to treat Medicare patients in their offices. Dr. Frederick Schnell, part of the five-doctor Central Georgia Cancer Care group and president of the alliance seeking corrections to the reimbursement rules, buys enough Aranesp (and Neulasta) to get a rebate from Amgen that provides a profit after Medicare reimbursement of about $47 a dose. Last year, his practice made about $400,000 from Aranesp rebates, he said, which pay for the practice's 20,000 square feet of office space, 60 employees and large pharmacy. ''Community oncologists don't ask for rebates,'' said Schnell. ''They're simply part of the system.''

That's a nice profit.

So all a Medicare covered participant has to do is change doctors if they want their medicine administered.

In addition, some hospitals and doctors used to waive the 20 percent Medicare co-pays for patients who couldn't afford them, but now they're less likely to be able to afford to do so and instead are becoming more aggressive about collecting, squeezing patients financially. For patients who require expensive intravenous treatments, such as certain cancer patients, the co-pays can balloon to thousands of dollars.

Thousands in copays.


And this is the system some politicians want to expand to everyone?

Medicare for all.

Perhaps they should change the name. How does Medi-No-Care sound?
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