Opinion

How Medicare Is Limiting Cancer Care for Seniors

By Brian Koffman
March 27, 2020 at 5:00 am ET

As a cancer survivor and health care provider, I’ve never felt more optimistic about the possibilities of new cancer treatments — or more worried that today’s care innovations will further health care disparities.

Every day, medical advancements inch us closer to beating this devastating disease. However, policymakers must ensure that no patient is cut off from today’s best treatments or tomorrow’s future innovations — especially some of our most vulnerable seniors.

Overall, outcomes for cancer patients are on a positive trajectory. In 2019, the American Cancer Society announced the largest single-year decline in cancer mortality ever recorded, falling 2.2 percent from 2016-17.

While the oncology community should celebrate these milestones, it must also recognize these numbers show there is vital work to do to ensure that there is continued long-term success in cancer survival rates.

One of the most promising therapies available is an immunotherapy that saved my life, chimeric antigen receptor T-cell therapy. CAR-T therapy works by reprogramming a patients’ own blood cells to seek and destroy cancer cells. Widely considered the future of cancer care, CAR-T has become a clinically proven, innovative option for patients with blood cancers such as lymphoma or leukemia who otherwise have limited treatment options and poor prognoses.

At the time of my chronic lymphocytic leukemia diagnosis in 2005, I had been practicing as a family physician for decades. I understood that my diagnosis came with grim prospects due to the limited treatment landscape.

My cancer was aggressive, and I needed an equally aggressive treatment, yet I had few viable options. It wasn’t until my third relapse in 2018 that I was able to enter a very early CAR-T clinical trial at Fred Hutch Cancer Research Center in Seattle. This saved my life and inspired me to advocate for others through the CLL Society, a nonprofit patient-education organization I co-founded.

Though I was incredibly fortunate — and still am today, in complete remission — many patients across the nation have not had the same opportunities.

Specifically, among my peers — Medicare patients who have paid into the system for decades have faced significant roadblocks in accessing CAR-T. This is in large part due to the fact that Medicare hasn’t established a CAR-T specific reimbursement code for hospitals to recover treatment costs that disincentivize the use of this innovative therapy and ultimately limit patient access.

Seniors who live in rural areas must overcome even greater challenges, as they may be located hundreds of miles away from the nearest treatment center offering these new therapies. Treatment locations are almost exclusively located in urban locations — largely concentrated in the eastern United States — making it almost impossible for many patients to receive this therapy.

And research has shown this geographic disparity and the financial burden placed on Medicare patients and providers have led to significant treatment delays. A recent study from The American Journal of Managed Care found that a six-month delay in CAR-T treatment leads to an average of 1.9 life years lost in diffuse large B-cell lymphoma patients.

Ensuring the widespread availability of innovative cancer care will require a coordinated effort between providers, advocates and policymakers alike. Policymakers need to push for a CAR-T specific Medicare reimbursement policy that will offer a permanent solution and guarantee America’s seniors can benefit from these life-saving treatments. Innovative therapies are paramount when it comes to successfully combating any disease; however, the importance of patient-focused policies cannot be understated.

When I was out of options, CAR-T therapy gave me back my life. Everyone deserves the same opportunity. Patients’ locations and coverage — whether Medicare or not — should not dictate who can be treated with potentially lifesaving therapies.

 

Dr. Brian Koffman is a retired medical doctor and the co-founder and chief medical director of the CLL Society, a nonprofit patient-education organization dedicated to addressing the unmet needs of those affected by chronic lymphocytic leukemia.

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