Tuesday, August 17, 2010

Avastin Goes Under the Bus [UPDATED]

[Please scroll down for update]

Let's say that you're being treated for breast cancer. Four-and-a-half years ago, Bob observed that folks "really don’t need health insurance for routine things like doctor visits for mundane afflictions or even for most meds. Instead, what they need is catastrophic coverage."

So what?

Here's what:

"Avastin is an example of a tier 3 or non-formulary medication. You won’t find it on any carriers list of meds that can be purchased for a $20 copay. Instead it will be in the non-formulary column that could carry a $60 copay or even higher."

Of course, that was then, and this is now:

"Federal regulators are considering taking the highly unusual step of rescinding approval of a drug that patients with advanced breast cancer turn to as a last-ditch hope.

The debate over Avastin, prescribed to about 17,500 women with breast cancer a year, has become entangled in the politically explosive struggle over medical spending and effectiveness that flared during the battle over health-care reform."


Here's the problem: it's one thing for Medicare, or a private insurer, to put a med on it's "less favorable" list; in essence, telling folks that they're going to pay more out of pocket for a given medication. But when the FDA rescinds approval for that drug, it means that it is no longer available, at any price.

Of course, given the predilections of our new CMS head honcho, Donald Berwick, this is of a piece with the idea that rationing care is the way to go:

"The FDA is not supposed to consider costs in its decisions, but if the agency rescinds approval, insurers are likely to stop paying for treatment."

The takeaway here isn't that insurers may stop covering Avastin [ed: another reason why consumer-centric health care could have been key] but that the gummint, in the form of Medicare and Medicaid, now have justification for denying coverage for it. And if you think they'll stop at Avastin, I have some prime property to sell you.

And who's the hardest hit? Not the elites: they have their own plans, and the means to pay for non-covered med's. No, the folks who will pay the ultimate price for this are those least able to afford it:

"...cancer patients would lose eligibility for a program in which Genentech caps the annual cost of the drug at $57,000 for women with annual incomes of less than $100,000."

That's aimed square at (what's left of) the middle class; those less fortunate (i.e. Medicare and Medicaid beneficiaries) pay that price, as well.

Poppa Washington: Be elite, or die trying.

UPDATE [from Bob]: “…while Avastin does not extend life, it does extend quality of life, alleviating pain and suffering for women who are suffering from late-stage breast cancer."

More Americans will not die if Avastin is withdrawn for breast cancer. But, since the agony of end-stage cancer will come sooner rather than later, almost 18,000 women a year will soon wish they were dead, thanks to Obamacare.
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