CMS to review cancer vaccine, analysis shows high Medicare drug spending not correlated with better care

Nov 9 2010

Washington Post: The Centers for Medicare & Medicaid Services "are conducting an unusual review to determine whether the government should pay for an expensive new vaccine for treating prostate cancer, rekindling debate over whether some therapies are too costly." The "national coverage review" will evaluate Provenge, the "first vaccine approved for treating any cancer," which was approved in April. "The treatment costs $93,000 a patient and has been shown to extend patients' lives by about four months. Although Medicare is not supposed to take cost into consideration when making such rulings, the decision to launch a formal examination has raised concerns among cancer experts, drug companies, lawmakers, prostate cancer patients and advocacy groups. … Medicare officials, who are convening a panel of outside advisers to vet the issue at a public hearing Nov. 17, say Provenge's price tag isn't an issue. But ... officials declined to discuss the rationale for the review" (Stein, 11/8).

HealthDay/USA Today: Meanwhile, an analysis of the U.S. Healthcare Effectiveness Data and Information Set  showed that more "drug spending don't necessarily translate into better quality care for Medicare patients," revealing "wide variation across the United States in both Medicare drug spending and the rate of inappropriate prescriptions for the elderly." The analysis, conducted by University of Pittsburgh researchers and published in the New England Journal of Medicine, "also found that regions where Medicare patients were more likely to get prescriptions for high-risk or potentially harmful drugs did not necessarily spend more on drugs overall than regions with lower use of high-risk or potentially harmful drugs" (Preidt, 11/6).