I believe her point is that she couldn’t get approval on Medicare for Tykerb as an outpatient drug. If it was in the same price range of Avastin etc., there wouldn’t be a problem.

from reading just a bit of Jeanne Sather’s blog, i don’t think that’s right. here’s what i mean: from Jeanne Sather’s blog showing, if i understand correctly, that medicare did cover her tykerb (via part D, not part B) — her problem was not that medicare deemed it medically unnecessary, rather her problem was with the cost of the copays and donut hole.

Tykerb only comes in pill form, however, which has been part of the problem with Medicare.

I have Medicare Parts A and B, which costs me about $100/month. I also have a supplemental policy through WSHIP, which is several hundred dollars more a month, and a prescription drug plan (Part D) that costs about $80/month.

As anyone who knows anything about Medicare will tell you, these prescription drug plans are not very good. There is the infamous “doughnut hole,” which requires you (me) to pay several thousand dollars out of pocket before coverage kicks in at a higher level.

In addition, my prescription drug plan, Medco, told me that the monthly copay on Tykerb is $1,600. Now, my income from Social Security Disability is only $1,100, minus my health insurance premiums, so this is not going to work.

But the big question I had, which no one seemed able to answer, is why a cancer treatment is not covered under Medicare Part B?

After all, the treatments I get by IV, Avastin and zometa, are covered by Part B and my supplemental plan. And other oral cancer drugs, namely cytoxan and xeloda, are covered completely by Part B and supplemental insurance.

So why not Tykerb?

Well, Dr. Lee, who I saw last week, had an answer. He said the reason oral cytoxan is covered by Medicare Part B is that there is also an IV version of the drug, which is more expensive to administer, because insurance is charged the costs of delivering the drug plus the actual cost of the meds. So Medicare covers the oral version also, which is cheaper, to encourage people to take the oral drug.

more later…..

The point I was making is that our Canuckistanian Universal system would be even better if we had controlled costs by not WILFULLY entering into a stupid extended patent protection program.

Why?

Because, now we have no leverage to bring down the costs of the blockbusters to reduce rationing (and make no mistake about it, we do have rationing on biologics because of the costs – which leads, for example, to women looking for a sympathetic oncologist who will go back to the pathologist in attempt to get that Her-2-stained section re-scored) and make the entire system more sustainable.

Which is why, in my opinion, Jane’s point is such an important one.

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I believe her point is that she couldn’t get approval on Medicare for Tykerb as an outpatient drug. If it was in the same price range of Avastin etc., there wouldn’t be a problem.

That is why precription drugs in Canada cost about 40% of what exactly the same drugs cost in the US. Our government acts for the good of Canadians, whereas your government apparently does not act for the good of Americans.

Canada has had a universal single payer health care system for 47 years which is far superior for the average Canadian than the US insurance-run health care system is for Americans. It is beyond me that Americans would stand for insurance company bureaucrats standing between them and their physicians, rationing their health care for profit. In Canada, government pays for our health care at arm’s length, leaving only us and our physicians to make our medical decisions. It is in the US that you have a bureaucrat, an insurance company bureaucrat making your medical decisions for you. Canadians would never tolerate having any inteference with our medical decisions by anyone other than our physicians and us.

It is clear that the US “for profit” insurance-run health care system and the US “for profit” pharmaceutical-run drug system are both killers and not made to be beneficial for the American people.