Right-wing blogger Jim Hoft thinks he's finally -- finally -- found those “death panels” Sarah Palin was talking about, claiming that the Obama administration has “cut” a “Medicare treatment for cancer patients.” This is completely false.
What Hoft is referring to is a Centers for Medicare and Medicaid Services (CMS) review of the prostate cancer drug Provenge. Citing another right-wing blogger's rantings on the subject, Hoft writes:
HERE COME THE DEATH PANELS...
For the first time in history Medicare will not cover an FDA-approved anti-cancer therapy.
Doug Ross reported:
Just days after the recess appointment of Donald Berwick, the controversial new head of Medicare and Medicaid, the Ovarian Cancer National Alliance posted the following grim news: for the first time in history, an FDA-approved anti-cancer therapy may not be covered by Medicare.
Provenge, a vaccine to treat the recurrence of prostate cancer, has been approved by the Food and Drug Administration (FDA)... Medicare usually covers the cost of FDA-approved anti-cancer therapies. However, the Centers for Medicare and Medicaid Services (CMS) is still reviewing whether it will cover Provenge, and at what rate.
The CMS statute states that Medicare must cover therapies that are reasonable and necessary, while the FDA is instructed to approve drugs that are safe and effective. Because of the conflicting Federal coverage and approval requirements, there are some non-FDA approved drugs (called off-label drugs) that are paid for by CMS. However, with respect to Provenge, it appears that CMS is arguing that while the treatment is safe and effective, it may not be reasonable and necessary. For the first time, an FDA approved anti-cancer therapy may not be covered by Medicare.
A life-saving cancer treatment “may not be reasonable and necessary” ? Gee, that kind of decision-making by an unelected federal bureaucracy certainly sounds like a death panel to me.
Let's take this apart piece by piece.
First, as the blog post Hoft links to makes clear, CMS is still reviewing Provenge to set their national coverage policy. Dow Jones reported on August third that even though the drug is under review, “nine of the 15 regional Medicare Administrative Contractors have established coverage guidelines for Provenge. Five others have stated that they will process Provenge claims, while one is not covering the drug. The company said it will work with that contractor--covering Arkansas, Louisiana and Mississippi--to ensure that patients have access to Provenge.” So Hoft's claim that “Medicare will not cover” the drug is false.
Second, the blogger he links to suggests that the Provenge review is the doing of CMS administrator Donald Berwick, which is ludicrous, given that the review was announced before Berwick was recess-appointed on July 7.
Third, no one really expects CMS to announce that Medicare will not cover Provenge. Writing for TheStreet.com, Adam Feuerstein surmised that CMS is conducting the year-long review because “local Medicare providers may have asked for it because they want guidance from CMS on how to cover Provenge,” and/or “given the uniqueness of Provenge, CMS may think it best to coordinate coverage nationally.” As Feuerstein wrote: “No cancer drug with a proven survival benefit has ever been denied insurance coverage before, and I find it hard to see how Provenge becomes the first.”
And fourth, “death panels” don't exist. They never have existed, and, by every indication, they never will.