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Picking Up the Tab

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Cancer medications can be as expensive as they are necessary, so having them covered by insurance is paramount for many patients. Medicare recently confirmed that it will continue to pay for two expensive cancer drugs — Genentech's Avastin for breast cancer and Dendreon's Provenge for prostate cancer — despite the recent debate surrounding their utility, reports The New York Times' Andrew Pollack. A spokesman for the Centers for Medicare and Medicaid Services says that FDA's decision to remove the breast cancer indication from Avastin's label won't affect Medicare's coverage of the drug. Medicare commonly pays for off-label use of cancer drugs, Pollack adds. The agency also recently undertook a national coverage determination to decide whether to pay for Provenge, which costs about $93,000 for a complete course of treatment, and now says there is adequate evidence to conclude that the drug is necessary for the health of Medicare beneficiaries, Pollack says. "The national coverage determination drew outcries from some men with prostate cancer, investors in Dendreon and critics of health care reform, who said the government was singling out the drug because of its cost and was on its way to rationing health care," he adds. "Similar accusations about rationing greeted the FDA’s proposal to remove the breast cancer approval for Avastin. Both Medicare and the F.D.A. said the costs of the drugs were not a factor in their deliberations." Now, it is up to private health insurance companies to decide whether to follow in Medicare's footsteps, Pollack suggests.

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