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‘Financial Conflict’ in Myeloma Oncologists’ Compensation?

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“Last week a myeloma patient told me his oncologist had switched him from Zoledronic acid (ZA) to a ‘new, easier’ option: denosumab. A recent @ASCO guideline in @JCO_ASCO said both were options. ZA is ~$70; Denosumab is ~$2000. The oncologist gets 6% of the drug he/she chooses.”

Yes, according to the study linked and excerpted below, Denosumab is “safer” than ZA in certain patients. But saying that it is “easier” than ZA tells the patient little if anything. Further, Denosumab is much more expensive than ZA. Many patients need to understand this fact. Oncology must explain their decision-making.

If you make a 10 or 20% copay a bone therapy that costs, say, $2,000 a month can really add up!

In the second article linked and excerpted below, prescribing of FDA approved therapies by an oncologist is called into question.

No one is immune from $ temptation We have a system that rewards oncologists and their chemotherapy offices with more $ for giving more expensive chemo. This has to change,” said Vincent Rajkumar, MD, a professor of medicine and a hematologist/oncologist at the Mayo Clinic, Rochester, Minnesota.

Considering Dr. Rajkumar is a top MM specialist, working at a world-renowned hospital the questioning of oncologist reimbursement practices is an idea that may cause considerable concern for MM patients, survivors and caregivers.

In a previous blog post, I cited research indicating that financial stress had a negative effect on MM overall survival.

In another blog post, I cited numerous studies in order to make an evidence-based argument for MM patients questioning cancer research.

If your oncologist’s recommendations are fraught with bias, what is an MM to do??? How is a layman who is diagnosed with incurable cancer supposed to make decisions? First and foremost, I am not saying that you oncologist is just plain wrong about what he or she recommends. I am simply saying that the interests of the patient are best served by the patient. Patients need more information in order to decide what is best for them. Knowledge is power.

Have you been diagnosed with MM? Scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Safety of Denosumab Versus Zoledronic Acid in Patients with Bone Metastases: A Meta-Analysis of Randomized Controlled Trials.

“Conclusion-Denosumab was safer in delaying or preventing skeletal-related events in patients with bone metastases and prevented pain progression compared to ZA in this meta-analysis.”

Oncologists Getting 6% of Drug Price Is ‘Financial Conflict’

“He (Dr. Rajkumar) was highlighting a controversial topic — Medicare Part B reimbursement for drugs that poses a “financial conflict” for oncologists in choosing which drug to prescribe.

The point was made in a Twitter thread that began with Rajkumar highlighting the case of a patient with myeloma who was taking a bone-targeted therapy to prevent skeletal-related events (SREs).

“Last week a myeloma patient told me his oncologist had switched him from Zoledronic acid (ZA) to a ‘new, easier’ option: denosumab. A recent @ASCO guideline in @JCO_ASCO said both were options. ZA is ~$70; Denosumab is ~$2000. The oncologist gets 6% of the drug he/she chooses.”

Not surprisingly, the tweet prompted a discussion that included a variety of opinions.

Rajkumar emphasized that his tweet was not about the merits of one drug vs another or what the guideline said or didn’t say or finding fault with colleagues. He wanted to highlight the current system. “It’s the Medicare reimbursement model that needs to change. For this, laws and regulations need to change,” he wrote on Twitter…

Distorted Model

Drugs that are administered by infusion or injection in physician offices and in hospital outpatient departments are covered by Medicare Part B, as are certain products furnished by suppliers.

Under the current system, oncology practices must buy the chemotherapy drugs up front. The cost for drugs may vary; in the United States, Medicare reimburses costs on the basis of the average sales price (ASP) plus 6%. The 6% is meant to cover any variation in the acquisition price, as well as overhead.

As Rajkumar noted in his Twitter thread, that means that providers will be paid more money for prescribing a more costly medication, even if a less costly and equally effective alternative is available — such as the case he highlighted with the myeloma patient being prescribed denosumab (Xgeva, Amgen) in place of zoledronic acid…

“We have a system where even if two drugs are equally effective, because of the reimbursement being greater for the more expensive drug, it puts a financial conflict for physicians who have their own dispensing facilities,” Rajkumar told Medscape Medical News

“The current system has physicians earning larger profits when they prescribe drugs that are more expensive,” said Peter Bach, MD, MAPP, director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York City, who was approached for comment. “This creates an upside-down market where drug corporations can garner increased market share by charging higher prices.”

The rationale for Denosumab?

The latest indication for denosumab is for the prevention of SREs in patients with multiple myeloma. A head-to-head comparison in this patient population found that denosumab was noninferior to zoledronic acid for time to SREs. The findings also suggested an advantage in reducing the risk for renal adverse events.

As previously reported by Medscape Medical News, the authors noted that there were “bone-specific benefits and observed prolongation of progression-free survival, in combination with a better renal toxicity profile,” with denosumab. Given these advantages, denosumab had the “potential to be the new standard of care for multiple myeloma-related bone disease.”

However, there were no significant differences between the groups in terms of overall survival. Adverse events were also similar between treatment arms, although renal toxicity was higher with zoledronic acid, and hypocalcemia occurred more frequently with denosumab.

Commenting on this head-to-head comparison, Rajkumar pointed out that the study did not mention the huge cost difference. “While it may be that both drugs are noninferior, one is inferior in terms of cost,” he said...”







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