Who Pays for an Expensive Prostate Cancer Drug?
More than 217,000 men will be diagnosed with prostate cancer this year. About 32,000 will die.
A newly approved drug can extend lives by several months but at a cost close to $100,000. CBS News correspondent Wyatt Andrews reports on Wednesday the debate in Washington was whether Medicare should pay for it.
Sal Cicero has advanced prostate cancer his doctors say is fatal. At 67 he's still working as a realtor and for that he credits the drug Provenge.
"The drug for me has given me basically and opportunity to continue my lifestyle," says Cicero.
Patient advocates like Jim Kiefert say Provenge is a medical breakthrough.
"The men who know about it are just standing in line waiting to get it," he says.
For tens of thousands of prostate cancer victims, Provenge equals hope. To make the drug, the patient's own blood cells are drawn and then exposed in a lab to a protein that mimics the cancer.
They're then returned to the patient essentially supercharged to attack the cancer. The issue is that it costs $93,000 per patient for four extra months of survival.
Those facts led Medicare officials to call in the experts to ask if Medicare should cover Provenge. Officials insisted this was not about the cost but patient groups were alarmed and said the meeting was all about the money, and worse.
"I see no other word to use in this case but rationing," one expert says.
The makers of Provenge call the drug a value at $93,000. They argue it can be less expensive than chemotherapy, with none of the horrible side effects.
"What is a breakthrough here is that the concept of using your own immune system to fight cancer represents a whole new era in medicine," says Dendreon CEO Mitchell Gold.
This whole new era is getting expensive. Other biologic drugs like Provenge made from cells now cost more than $21,000 per patient. Traditional drugs cost $1,100, which means these breakthroughs could one day break the bank.
"And they need to figure out how to rein this in if we're going to be able to keep the pharmacy benefit off the extinction list," says Senior VP and Chief Medical Officer at Express Scripts Dr. Steven Miller.
It's likely that Medicare will cover Provenge, but only for patients whose cancer has spread. It's a crucial decision because typically most private insurance companies follow Medicare's lead.
