Medicare Cuts , p3

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In clinical trials, they have proven as good as or better than standard treatments for non-Hodgkins lymphoma, a cancer of the immune system. In a trial of 414 patients scheduled to be discussed next Monday at a hematology conference, the combination of Zevalin and chemotherapy put lymphoma into remission for three years on average, compared with one year for chemotherapy alone.

Marion Swan, a spokeswoman for the Lymphoma Research Foundation, says the drugs are the only option for some patients. “Our No. 1 concern is that patients have access to all viable treatment options,” she said, “and it looks like this might be denying access.”

The drugs can require private cancer doctors to transfer their patients to hospitals, and the private doctors may view the hospitals as competitors. As a result, fewer than 10 percent of patients who are candidates for the drugs get them.

Advocates for the drugs had hoped that new clinical trial evidence, like the Zevalin data that will be presented next week, would persuade more doctors to prescribe them. Now they worry that Medicare’s decision will end most use of the drugs and chill the development of other radioimmunotherapies.

“If you can’t get two products that basically hit home runs into the marketplace, there’s very little incentive for further development,” Dr. Kaminski said.

Herb B. Kuhn, deputy administrator of the Centers for Medicare and Medicaid Services, the agency overseeing Medicare, said that the agency recognized the value of the drugs. But, he said, Medicare does not want to overpay for the medicines and believes that hospital data is the most accurate way to set reimbursement.

But most other drugs administered via injection in doctors’ offices or hospital outpatient clinics — as Bexxar and Zevalin are — are not reimbursed on the basis of what hospitals say they have paid. Instead, companies report the average price of their drugs to Medicare. Medicare then reimburses doctors and hospitals at that



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