Promising ovarian cancer drug not covered by Medicare in Colorado
The Denver Post
A promising new drug to treat ovarian cancer is giving hope to women battling the ruthless disease, expected to kill 210 Coloradans and more than 14,000 other Americans this year.
For women who happen to live in California or New York, Medicare pays for the monthly injections of Avastin – which can cost $7,000 to $15,000 apiece. Women in Colorado, meanwhile, are digging into retirement accounts or going without the drug because Medicare refuses to cover it here.
The disparity has outraged Coloradans, who have asked federal lawmakers to fix it.
“I call that criminal,” said Elaine Rueb, a Denver woman paying for her own Avastin injections. “It’s just ridiculous. Medicare is a federal program, yet we have these regional rules that are different?”
The reason Medicare rejects claims for Avastin in Colorado is that its contractor – the Dallas company that processes its claims – decided not to cover it. Absent a national coverage decision, and there isn’t one regarding Avastin for ovarian cancer. Local Medicare regions make their own coverage decision, said Mike Fierberg, spokesman for the Centers for Medicare and Medicaid Services in Colorado.
The U.S. Food and Drug Administration has approved Avastin for other cancers, including colon cancer. In the last couple of years, oncologists across the country started prescribing it “off-label” for ovarian-cancer patients.
Medicare contractors consult lists of scientifically reviewed drugs, called compendia, to determine whether to cover drugs for off-label use. The Medicare contractor for Colorado, TrailBlazer Health Enterprises, “is more conservative than the others” and consults four compendia, Fierberg said. One of the four did not support using Avastin for ovarian cancer because a clinical trial was terminated due to adverse effects, including serious bleeding.
Sen. Michael Bennet, D-Denver, has urged the Colorado Medicare office in a letter to push its contractor to cover Avastin.
“It makes no sense that an ovarian- cancer patient can be denied access to this proven cancer drug just because she happens to live in Colorado,” Bennet said. “All women should have access to these treatments, whether they live in Minnesota, California or Colorado.”
Annette McElhiney cashed in her savings to pay for four Avastin treatments in Colorado, spending close to $27,000.
Then the retired Metropolitan State College of Denver professor had two Avastin treatments near her winter retreat in Palm Desert, Calif., and mailed a fat check to the infusion center. When the clinic returned the money and told her Medicare picked up the bill, McElhiney was shocked and then “enraged” by the inequity.
Now she travels to California every three weeks, using her husband’s frequent-flier miles, for 30-minute Avastin injections. She’s been in remission for six months and believes the drug is helping.
Dr. Susan Davidson, a gynecological oncologist at the University of Colorado Denver School of Medicine, has prescribed Avastin for several patients. A couple had private insurance that covered the drug and a few got the drug manufacturer to subsidize the cost.
But several patients on Medicare are going without it.
“It feels like my patients are being discriminated against,” Davidson said. “It’s just unbelievably unfair. I can’t understand why the policy for Medicare can’t be uniform in this country.”
Avastin works by inhibiting the growth of new blood vessels, which carry nutrients to a tumor.
Rueb, who was diagnosed with ovarian cancer nearly four years ago, has had little break from chemotherapy since then. She is spending her savings on Avastin treatments but that “won’t last forever.”
“You do run out of options after awhile,” the 59-year-old said. “It’s pretty tough.”
Jennifer Brown: 303-954-1593 or email@example.com
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