Group slams CMS cost plan for prostate cancer


health and moneyWASHINGTON, Oct. 30 (UPI) -- A patient coalition Monday demanded that U.S. Medicare drop its policy of "least costly alternative (LCA)" for prostate cancer patients.

The LCA policy encourages doctors to give patients the treatment that costs the least money in cases where treatments are deemed interchangeable by the Centers for Medicaid & Medicare Services (CMS), which drives providers to make treatment decisions based on cost, rather than clinical factors, said a coalition comprised of the Men's Health Network, the National Prostate Cancer Coalition, the Prostate Health Education Network Inc. and Us TOO.

In a joint letter to the Medicare Payment Advisory Commission -- which is set to meet soon over other Medicare payment issues -- the group set out its concerns over CMS's current LCA policy, including that:

  • Physician judgment is supplanted by cost factors.
  • The cost of therapy from quarter to quarter could cause sudden changes in treatment based on cost, not efficacy.
  • By shifting the difference in cost of the LCA treatment with more expensive treatments to the patient, the policy discourages patients from seeking the most appropriate treatment.

"LCA policies for prostate cancer drugs are inappropriate because they substitute Medicare's determination that certain drugs are interchangeable for the physician's professional judgment that one drug may be more efficacious or have fewer side effects for a particular patient," the group wrote in the letter.

"All things being equal, cheaper is of course always perceived as better," said Scott Williams of the Men's Health Network. "But all things are not equal. This is treatment for cancer and the impact of the LCA means that the treatment you get is not based on what is best for you, but what is cheapest. That simply isn't fair to the patient who is fighting for his life. It is past time for CMS to review and remove policies that threaten rather than support patients."