14 Reader's Comments
Page
Data by Profession and Location
DEAN TSARWHAS, MD | Physician | Disclosure: None LIBERTYVILLE ILNovember 08, 2011
Integrity among Medical Oncologists
I am writing to defend the thousands of medical oncologists in community and academic practices who do not prescribe particular chemotherapy regimens based on maximizing financial profits but based on approved treatment guidelines, pathways, and what is best for the patient. The article is truly a "slap in the face" for the hard working oncologists who provide countless hours of unreimbused time caring for some of the sickest patients in medicine. The article fails to mention that the "drug margin" primarily goes to cover the numerous under-reimbursed expenses involved with providing cancer care in the community setting. Since the advent of the MMA, the ASP+6% reimbursement is often under our acquisition cost, making it impossible to treat the patient in the cost-effective office setting, and as a result, the patients are treated at the hospital where it is costlier and often more inconvenient. Finally, many medical students and medical residents choose a career not only based upon their passion, but also upon financial considerations. To suggest that oncologists should be salaried as at the VA would exacerbate a workforce shortage that already exists.
DANIEL LANGER, MD | Physician | Disclosure: None WINDSOR CONovember 03, 2011
Price fixing.
Economics 101. Price fixing = drug shortages.
Han Zhong | Other | Disclosure: None Madison WINovember 03, 2011
ASP not AWP
Why does the table list the AWPs of comparable drugs when physicians are reimbursed at ASP+6%? Actual Medicare Part B drug reimbursement at ASP+6% is often significantly lower than AWP.
Just look at the CMS Medicare Part B drug pricing file
https://www.cms.gov/mcrpartbdrugavgsalesprice/
Just looking at Paclitaxel vs. Abraxane, Abraxane is more expensive at ASP+6%, but it is also significantly more effective. Is it worth the difference in price? Ask a cancer patient if they want a less efficacious drug to treat their life-threatening condition.
THOMAS WAGNER | Other | Disclosure: None SNELLVILLE GANovember 03, 2011
The faliure of economic homeopathy
Why is the answer to a market failure caused by inane regulatory action always more inane regulatory action, instead of removing the regulatory thumb from the market's windpipe? This is reminiscent of homeopathic theory, where the cure for a disease is a drug that reproduces the symptoms of the disease, without homeopathy's saving grace of dilution to extinction.
ROGER WILGUS | Other | Disclosure: None
November 02, 2011
What an Astounding Situation
I worked in the health care field for more than three decades and was unaware of the absurd situation described, wherein oncologists sell drugs to their patients at cost plus a percentage. This situation simply begs for abuse, which is clearly occurring. Only our governmet bureaucracy could countenance such a situation, after having permitted it to begin.
Whether oncologists need this windfall to obtain fair compensation for their services is beside the point. There are other ways to provide them such remuneratiion -- ways in which patients and the taxpayers aren't negatively affected. This deplorable situation should be halted at once.
GEORGE CALDWELL, MD | Physician | Disclosure: None SINGAPORE SingaporeNovember 02, 2011
Benzbromarone shortage
For the treatment of Acute Gout the combination of Colchicine with Benzbromarone ("Narcaricin") is excellent.
No longer is Benzbromarone available unless someone knows of a new manufacturer.
Don't try and teach me.
Allopurinol is for defectives who will not observe careful diet.
Do they yet know that an excess of Fructose will cause a delay in the kidney's ability to excrete Uric Acid? That is, Bananas and Mangos, Dates and figs and nectarines can produce Gout just as Prawns and Squid will.
Anyone got any "Narcaricin" (Benzbromarone)?
THOMAS MONAGHAN, MBBS | Resident - Neurology | Disclosure: None MEATH IrelandNovember 02, 2011
A physician should not profit from a prescription
In our country we have strong laws that prevent any association between a prescriber and the dispenser for obvious and sensible reasons. Therefore I was somewhat horrified when I came to understand this article and that the oncologist profits from the dispensing of the drug.
Of course bringing this to its logical extension one might question the prescriber of angioplasty also being the person who may materially "profits" from it. This has of course been addressed worldwide with concerns about pay-for-procedure. Perhaps it is not that different from the concerns expressed here.
Perhaps it is therefore a cultural thing, or that I am a product of a semi-socialised system (full of it's own ills), but I remain deeply concerned about the act of profiting from prescribing a medication. We are beyond the spectrum of a few pens from a drug representative or a trip to a conference here. Maybe those geriatricians should be marking up and selling the donepezil...
ROBERT HAMILTON | Other | Disclosure: None COLCHESTER VTNovember 01, 2011
Reimbursements
Instead of reimbursing oncologists at cost plus a percentage, reimburse at cost plus a fixed fee. This removes the incentive to use more expensive drugs to maximize the percentage reimbursements.
JEFF SOURBEER, MD | Physician | Disclosure: None
November 01, 2011
The inevitable result of the attempt to fix prices.
This is an excellent analysis, except for the statement implying the need to move from a market-based solution. Such shortages and perverse incentives are the natural result of the attempt to control prices by fiat (government regulation). The failure is not that of a market system so much as it is a failure of a mis-regulated market system, with prices fixed by Medicare for both the drugs and the services. The Medicare system fails to appropriately reward oncologists for their cognitive efforts and the real costs of administration of chemotherapy, leaving them reliant upon "ancillary income" from drug sales. This is a fine illustration of the Rule of Unintended Consequences that attends bureaucratic management of a complex system. Medicare compounds the shortages of the drugs by its pricing mechanism, as is so well highlighted in the article. It creates perverse incentives for providers, such as those cited.
JAMES COWELL, PHD | Other | Disclosure: None HOLLY SPRINGS NCNovember 01, 2011
Abraxane vs paclitaxel use
The authors strongly imply that many oncologists use Abraxane over paclitaxel for their patients simply for a higher profit for their practice. I suggest that this is not a good example to draw such a conclusion, since it my understanding that there are important advantages for use of Abraxane from the standpoint of reduced adverse reactions compared to the use of paclitaxel.
PROF RAGHUNADHARAO DIGUMARTI, MD | Physician | Disclosure: None HYDERABAD IndiaNovember 01, 2011
Cancer Drug Shortages
Cancer Drug Shortages in the US can be easily overcome by importing drugs from high quality, US FDA Certified manufacturers outside the US, especially from countries in the developing world, like India and China
ROMI SZAWLOWSKI | Other | Disclosure: None CanadaOctober 31, 2011
Forecasting demand
I sense the need to reexamine customer demands and forecasting methods.
SIMON QUILTY, MD | Resident | Disclosure: None CASUARINA NT AustraliaOctober 31, 2011
Pharmaceutical security an international issue
This issue is of international importance, with Australia having many shortages in the last few years, most recently intravenous benzylpenicillin.
Pharmaceutical supply chain in the global economy requires governments to mandate notification of manufacturing failure, quaIity, or supply compromise and share this information globally. Individual nations need to identify "essential" medicines and specifically legislate for secure manufacture and supply of these exceptional drugs. International efforts need to focus on strategies to diversify manufacturing of such essential medicines.
JOHN WILLIAMS, MD | Physician | Disclosure: None WESTPORT CTOctober 31, 2011
Drug "shortages" and government intervention
Only the government could be responsible for such price dislocations.
The president's executive order will only make things worse.
The government should not get involved in "medicine"' and other places they don't understand! Only the government could be responsible for such price dislocations.
Page
