The Access to Cancer Therapies Act, making its way through the House and Senate, would expand reimbursement to include every oral cancer therapy approved by the U.S. Food and Drug Administration.
Medicare, the government's insurance program for the elderly, has no prescription drug benefit. The program's Part B rules provide coverage for oral cancer drugs that have intravenous equivalents, as well as those administered at a doctor's office.However, more-targeted and less-toxic treatments don't meet these criteria. As a result, elderly patients of few means can't get government help paying for Gleevec, Novartis' breakthrough drug for leukemia, or tamoxifen for breast cancer. These and other novel therapies now make up about 5 percent of the cancer armamentarium, a figure that's predicted to reach 25 percent of the market by the end of the decade.
"In the battle against cancer, access to cutting-edge therapy can mean the difference between life and death," U.S. Sen. Olympia Snowe (R-Maine), a supporter of the act, said in a statement released today. "Scientists are making new, less toxic, more targeted and more effective therapies available on what seems like a daily basis."
Yet these drugs aren't covered under Medicare, so poor beneficiaries can't afford them. "We happen to believe 'lesser means' should not mean 'lesser care,'" Snowe added.
"Cancer disproportionately affects Medicare beneficiaries. But there is an artificial financial barrier [to treatment] because Medicare coverage has not kept up to date with the emerging technologies and therapies," said Steven Friedman, director of policy at the National Coalition for Cancer Survivorship, an umbrella group for patients, hospitals, cancer organizations and other institutions.
Roughly 62 percent of all cancers are diagnosed in Americans age 65 or over -- in other words, those eligible for Medicare -- according to the American Cancer Society. One fifth of the program's 41.5 million enrollees, or about 8.3 million people, have been diagnosed with at least one form of the disease.
Friedman's group released a poll today showing that 88 percent of Americans believe Medicare should pay for more oral cancer treatments. The change would cost $438 million in 2002, and $2.8 billion over five years. That's a tiny fraction of the $78.5 billion Medicare will spend on cancer care this year, Friedman noted.
Friedman and his fellow advocates were joined by patients and lawmakers at a press conference this morning in support of the Medicare expansion. Afterward, the Senate finance subcommittee on health care held a hearing on the measure, which has bipartisan support in both houses of Congress.
The proposed law also has backing from many cancer groups, such as the American Cancer Society, as well as advocates for the elderly, including the AARP. The retiree group is also among the chorus calling for a comprehensive drug benefit that would cover every pill seniors take.
Unice Lieberman, a spokeswoman at the American Cancer Society's Washington, D.C. office, said the change would let patients take pills for their disease rather than intravenous medications.
"It seems to me that taking a pill is much easier on the patient, and that's what it's really all about," Lieberman said.