Medicare to pay for pricey cancer drug

Medicare will soon start paying for a new and pricey cancer medication, Blincyto, which costs about $178,000 for a standard course of treatment.

The latest news from President Barack Obama's administration suggests new willingness by Medicare to cover costly treatments for chronic conditions, reports the New York Times. Officials decided that the drug was a significant improvement over existing treatments after hearing pleas from the drug's manufacturer, Amgen.

The issue at hand is the add-on payments Medicare makes to hospitals for new technology. However, these costs have yet to be incorporated in the total amount hospitals receive for treating patients with certain conditions.

In April, the administration said it had no intention to pay extra for Blincyto because clinical studies did not provide enough evidence that the drug improved care for Medicare beneficiaries with acute lymphoblastic leukemia. Officials also said that the data Amgen presented did not reflect the appropriate demographic of eligible Medicare consumers, notes the article.

The new rule--which is set to be published in the Federal Register Aug. 17--says Medicare will allow for a "new technology add-on payment" to hospitals for a portion of that amount, up to $27,000. The actual payment will depend on the duration of a patient's hospital stay.

The decision comes on the heels of President Obama's plea to Congress to let Medicare officials negotiate prices with drug manufactures. As of late, health insurers have been eager to strike a deal with pharmaceutical companies, especially considering the backlash pver Gilead's Sovaldi last year when the company placed a $100,000 per person price tag on the drug, FierceHealthPayer previously reported.

For more:
- here's the NYT article

Free Webinar

Take Control of Your Escalating Claim Costs through a Comprehensive Pre-payment Hospital Bill Review Solution

Today managing high dollar claim spend is more important than ever for Health Plans, TPAs, Employers, and Reinsurers, and can pose significant financial risks. How can these costs be managed without being a constant financial drain on your company resources? Our combination of the right people and the right technology provides an approach that ensures claims are paid right, the first time. Register Now!

Suggested Articles

CMS is proposed to lower the user fee for ACA exchange insurers and wants to enable the private sector to develop competing signup websites.

With the distribution of a COVID-19 vaccine looming, companies in the pharmaceutical supply chain are working overtime to plan for all contingencies.

The pandemic is transforming the way the healthcare industry handles payments. Here are key takeaways on the benefits of automated payments.