Breast Cancer Patients Deserve Better: Policy Must Support Innovation

October 31, 2013 Categories: All News, ACLA In The News

October is National Breast Cancer Awareness Month. During this time, those of us in the advocacy community take stock of the millions of lives that have been affected forever by this dreadful disease. Breast cancer ranks second as a cause of death in women. Each year, about 230,000 women, and more than 2,000 men, receive a diagnosis of invasive breast cancer.

Cancer survivors, caregivers and doctors tell us that the most powerful weapons against breast cancer are early detection and the elimination of “trial and error” therapies. This is accomplished by pinpointing the most effective treatment options immediately after diagnosis.

Fortunately, new tests are in place that can help a patient make these decisions. Unfortunately, treatment options also are shaped by health care reimbursement policies.

Maintaining the highest quality care with the greatest efficiency is a strong mandate in the health care system. Yet, extreme cost cutting measures have sometimes been implemented instead of targeting strategic areas of cost savings.

This can cause patients to suffer from ineffective and sometimes painful treatments that they should not have to endure. We are seeing again that those in Washington, D.C., are putting cost control before treatments.

We all can show our support for breast cancer patients by wearing pink, but that is not enough. We need to make sure policymakers hear from us too. The impact of their decisions could obstruct access to new tests for hundreds of thousands of patients.

We’re especially concerned about an announcement made this summer by the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicare. They have announced plans to cut payments for life-saving tests that are used to help detect and determine treatment for breast, ovarian, and other deadly cancers. The cuts, set to take effect in 2014, place the reimbursement that laboratories receive for these tests below the cost of actually providing them.

The consequences of this action could potentially spell disaster for those breast cancer patients who rely on Medicare to help pay for life-saving services.

One particular test that would be affected helps determine if a woman’s breast cancer would respond to the drug Herceptin. Roughly 15-20 percent of all breast cancers can be treated with this drug, which requires the purchase of a $150 test kit.  Under CMS’ proposal, it would only pay $40 for this test. This is a proposed cut of 80 percent! Without this test, a woman may be forced to undergo expensive and ineffective chemotherapy treatment.

Timing is critical; lives are at stake. Inaccurate or delayed testing could have deadly results. The costs of these diagnostic tests are miniscule compared to the price of prescribing the wrong cancer therapy.

That’s what makes this proposal penny-wise and pound-foolish. If payment rates for these critical tests fall below the cost of providing them, we know that access to care can be compromised, particularly for those most at risk.

For example, a few years ago, reimbursement rates for mammograms were reduced. As a result, fewer women were able to access this vital testing, particularly in rural areas.

Bottom line: This “cost-cutting” decision will actually increase costs, threaten the availability of life-saving lab tests, and worsen the quality of breast cancer treatment for Medicare beneficiaries.

Breast cancer patients suffer enough. They and their families and caregivers are already subjected to a lot of stress and pain without the added anxiety of ineffective treatments, which could put the patient through months of side effects for no overall benefit to their health.

Every breast cancer patient should have access to the entire range of innovative tests available in his or her fight against this all too common disease.  Our nation’s leaders should not keep patients and their physicians from the weapons they need in this battle.  Breast cancer patients deserve better than this.

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