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Medicare Aims to Make Patients Quit Lupron, Switch to Zoladex or Pay Extra
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November 1, 1998 A new Medicare policy being sought by insurers in Southern California and other states will push prostate cancer patients off Lupron and onto Zoladex in order to cut costs. If this policy goes through, patient advocates say, it will limit prostate cancer patients' rights to choose medical treatment on the advice of their doctors.
Transamerica Occidental Life Insurance, which administers Medicare in Southern California, has announced a new policy restricting treatment choices for prostate cancer patients on hormonal therapy drugs. The company wants patients to be forced to choose Zoladex instead of Lupron -- or else lose full Medicare reimbursement and pay the extra cost of the drug themselves.
A patient who wants to stay on Lupron (or start on it) in preference to Zoladex will have pay around $125 per month out of pocket. Many patients prefer Lupron because the injection method is less painful.
Harry Pinchot, a prostate cancer survivor advocate in California, says that this new policy will mean that medical decisions will be based on the cheapest available treatment option regardless of the patient's condition or his doctor's judgment. This will have a serious impact on patient choice and quality of care, says Pinchot.
"Medicare is putting its own cost-cutting ahead of the well-being of the patient," Pinchot says. The policy is "discriminatory" Pinchot said in a mailing last week to more than a thousand prostate cancer patients. "It is likely to create a two-tiered Medicare system in which our right to choose medical treatments is limited by a patient's ability to pay."
The new policy is already installed in Florida. It is under discussion in California, Oregon, Alaska, Arizona, Nevada, and Hawaii. Patient activists believe that the policy will spread to other drugs used for treating prostate cancer and other diseases.
In California, Transamerica Occidental Life Insurance will accept comments on the proposal until December 13th. The other states have even shorter discussion periods. Pinchot says, "We must act quickly. Prostate cancer patient advocates, Medicare patients and anyone who cares about preserving the right to control their own health care must let their voices be heard!"
Pinchot is asking patients and supporters to send letters to elected officials. "Every letter counts," Pinchot said at the end of last week. "All cancer treatments should be determined by a patient and his doctor - not by the government or insurance companies. Act now to preserve prostate cancer patients' ability to choose the best treatment for their disease."
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