The overwhelming majority of cancer drug therapy (90-95%) is currently covered by Medicare Part B because the drugs are injectable and are administered incident to covered physician services. In addition, some oral anti-cancer drugs are covered by Medicare Part B is there is an injectable version of the same drug that would be reimbursable if administered by a physician.
Medicare coverage IS NOT available for widely-used hormonal agents for breast and prostate cancer, or for oral anti-cancer drugs that do not have an injectable equivalent.
Implications for New Oral Drugs
Cancer care in the future will be more heavily dependent on oral drugs; it is projected that oral drugs will comprise 25% or more of the oncology market within the decade. The new oral anti-cancer drugs include anti-proliferative agents such as signal transduction inhibitors (STIs), farnesyltransferase inhibitors (FTIs) and antiangiogenesis factors.
Oral anti-cancer drugs recently approved by the FDA and others nearing approval offer great hope for individuals with cancer. These drugs include STI-571, or Gleevac, a promising new treatment for CML. However, Medicare beneficiaries will not enjoy coverage of those drugs without changes in the program.
Recommendation for Action
Leukemia, lymphoma and myeloma advocates urge Congress to enact H.R. 1624/S. 913, the Access to Cancer Therapies Act of 2001, to provide Medicare Part B coverage of oral anti-cancer drugs.
Cancer patients and their physicians should not make decisions about care unduly influenced by the cost of care. Anti-cancer drugs are not discretionary for cancer patients, and there should be no delay in starting therapy or interruption in care as a result of financial concerns.