Today’s New York Times had a most distressing, but not surprising article, written by Reed Abelson, discussing the probable trend we will see in the near future in cancer treatment reimbursements. In a cost cutting experiment, the United Healthcare insurance company (UHC), will be starting a pilot project which entails paying medical oncology practices to not prescribe certain cancer treatments!

The project, due to be announced today, will be a one year pilot project where UCH will pay five different oncology practices an additional fee to only prescribe certain treatments and not use other treatments. WellPoint, another large insurer, is also in the process of working out special arrangements with some of their oncology practices. Besides UCH and WellPoint other regional insurers in California, Washington and Pennsylvania are actively negotiating similar programs.

The insurers, when explaining the program, claim their goal is to lower their costs by encouraging doctors to follow standard treatments rather than opting for individualized and unproven courses of therapy, which can include the most expensive drug combination. They claim that establishing a different payment structure will lower the doctors’ dependence on a system that generates substantial sums for cancer specialists who routinely favor top-of-the line treatments.

The insurance company’s spin doctors have been hard at work, making the case that a lot of treatments prescribed by oncologists are only a waste of resources. They argue that many expensive treatments have no effect or are given to patients at the very end of their life without any hope of saving their life. In some cases this is true, however, in many other instances this claim is just a smoke screen to save money.

A good example of the spin doctor’s perspective was restated by Mr. Abelson when he said that by paying oncologists not to prescribe certain expensive treatments they will be able to ensure that terminally ill patients are not subjected to unnecessary, often exhausting treatments that provide no hope.

In prostate cancer there are a number of “unapproved” treatments that clearly have a positive effect. Specifically, I am referring to the second line hormone manipulations, ketoconazole, estrogens and Leukine, all of which would probably not be prescribed under this type of arrangement.

Insurance companies have reasonable cause to be concerned about the yearly double-digit increases in the cost of cancer care. Insurers are quick to promote the new measures as a way to extract cost savings. They are now claiming that that terminally ill patients are subjected to unnecessary, often exhausting treatments that provide no hope.

I cannot help but remembering a friend who recently died from breast cancer. She was a single, working mother with one child in college. She opted to have a certain chemotherapy which she knew would not offer her any life extension, but it did over some palliative benefit. Because of the therapy she was able to stay at work as well as improve her quality of life, brief as it was. I also need to reflect on the use of retrovirus treatments that today are common in the treatment with individuals with AIDS. Twenty year ago many of the people alive today with AIDS would not be if it weren’t for their use.

These types of programs do represent a step toward denying patients additional treatments or the latest chemotherapy regimen based solely on the cost. It is difficult not to be concerned that oncologists will decide to withhold a treatment to obtain a payment from the insurance company. There had been a lot of concern expressed about medical care rationing while the debate raged about the recent changes in medical insurance in the United States. My concern and guess is that there will be rationing, but it will be sneak into the system through programs like the one being announced by UHC.

I do urge that you do read the entire article by clicking here

Joel T Nowak, M.A., M.S.W.