Medicare & Medicaid Cancer Patients Can't Get Easy Treatment for Anemia

The Center for Medicare and Medicaid Services (CMS) released information yesterday that has oncologists (cancer specialists) across the country up in arms. The CMS has said that Medicare cancer patients can't get treatment for anemia unless they want to pay for it out of their own pocket.

"CMS has reversed over 15 years of clinical experience in the treatment of Medicare patients with ESAs without offering appropriate scientific evidence to support such a drastic change. This action ignores the substantial scientific evidence submitted during the course of the CMS review, and dramatically alters the standard of care for Medicare cancer patients," said Dan Cohen, US Oncology Senior Vice President of Government Relations & Public Policy.

Anyone can become anemic. Anemia happens when your cells don't get enough oxygen, and they can die. All of our cells need oxygen to survive. Red blood cells carry oxygen to the cells in our body. When we don't have enough oxygen in our cells, we are considered anemic.

It's common for cancer patients who are receiving chemotherapy or radiation treatment to become anemic. Cancer treatment is designed to kill the cancer cells, to stop them from growing and multiplying.

Before this decision, cancer patients who developed anemia were given a pretty simple treatment - they were given the drug ESA. Why are ESAs important? ESAs are important in treating cancer patients who are getting chemotherapy or radiation treatment because of how they work.

ESAs are drugs that are injected into the body. They stimulate the body to make more red blood cells. This helps treat, and ultimately recover from, anemia. This has been the standard treatment for cancer induced anemia for years.

The ruling by the CMS will change this treatment. Under this ruling, Medicare and Medicaid cancer patients who develop anemia won't be able to get this injection. Instead, anemic patients will be forced into a more expensive and riskier treatment - they'll have to get blood transfusions to treat their anemia.

According to the oncologists, blood transfusions are more expensive than ESA treatment. Blood transfusions also carry more risks. You can die if you get the wrong type of blood, cancer patients might refuse blood because they're afraid of receiving blood from strangers,

People who have private insurance won't be subject to this decision. If their insurance covers it, they'll still be able to get ESA treatment. We'll end up with a two-tiered system for medical care. Those with private insurance will get the better treatment.

Cohen said, "Medicare beneficiaries who are battling cancer are already fighting for their lives. They should not have to also be battling Medicare coverage policy for treatments that their personal oncologists regard as necessary."

Sources:
http://en.wikipedia.org/wiki/Anemia
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/09-25-2007/0004669846&EDATE=