Will the Centers for Medicare & Medicaid Services (CMS) be able to optimize patient care with regard to both on-label and off-label drugs?
CMS’, at this time, has not shown itself to be either in favor or against new technology or the introduction of new uses for drugs. They still seem interested in promoting access high-quality care for their beneficiaries despite the current political pressure to limit costs (as supported by their recent decision to approve Provenge)
The real issue will be long-term as government agencies try to control budgets. The most likely target for a change will be in the area of “off label” use of drugs. Oncology uses the compendium as evidence, but CMS will most likely try and move away from this practice, discarding their willingness to pay for “off label” drugs. This could be oncology’s biggest threat in the future. It is possible that “off label” use of drugs will no longer be reimbursable, a disaster for many of us fighting cancer.
Medicare is running out of money and that ought to scare us all. We have yet to develop a plan for dealing with this problem. Under current formulas the Trust Fund will be gone by 2029. There has not been any movement to deal with this problem, but it looms in our very near future and is dangerous. We have an aging population which will drive up costs, but we don’t have a plan to deal with this crisis.
Joel T Nowak, M.A., M.S.W.