As I write this, I feel fortunate I've been able to receive radioimmunotherapy (RIT) to treat my follicular lymphoma--a breakthrough treatment that's produced amazing results for so many people.

I may not have realized just how fortunate I was though, because a recent government ruling, if it stands, will surely kill radioimmunotherapy as an option for others.

A powerful article appearing in Newsweek magazine today outlines the travesty, and what we're up against.

The Centers for Medicare and Medicaid Services (CMS), which has the power to set reimbursement rates for treatments received by Medicare and Medicaid recipients, has issued rulings for reimbursement in 2008. As part of this ruling, they have drastically cut reimbursement for radioimmunotherapy. Not by just a little, but by 50%. At the levels they've adopted, the reimbursement for RIT will actually be less than the acquisition cost for the therapy--meaning hospitals will lose money by providing the treatment for lymphoma patients. At the same time, the CMS ruling maddeningly states, "(CMS) may terminate the provider agreement of any hospital that furnishes this or any other service to its patients but fails to also furnish it to Medicare patients who need it." In other words, it demands hospitals either provide the treatment to all and lose money, or provide the treatment to none to avoid jeopardizing their provider agreements.

It seems to me this is an equation even a government bureaucrat should be able to figure out. If any hospital has a choice between providing a service that loses money (several thousand dollars) each time they do it, or declining to offer that service, which will it be?

If the CMS ruling stands, then, it will kill the two radioimmunotherapy treatments available (Bexxar and Zevalin), and at the same time kill research in the entire radioimmunotherapy field--which has produced durable remissions (and some may say a cure) for lymphoma types currently classified as incurable. Let me say that again: the CMS is killing an effective treatment, and a possible cure, because they refuse to look at the true cost of this treatment--the cost of providing it, and the cost, in human lives, of denying it to people who desperately need it.

During the short comment period offered on the proposed ruling, more than 2,000 people weighed in with comments/support for re-examining proposed payments for Bexxar and Zevalin--either by petition or direct comment. In addition, several healthcare companies and organizations such as the American Society of Clinical Oncology and the American Society of Hematology wrote letters of concern. CMS, in its final ruling, swept those comments under the rug by saying, "given that the Medicare population is such a dominant portion of the population to which these services are targeted, we do not believe that hospitals will cease to provide the service." Unfortunately, CMS admits it based these reimbursements on faulty claims data in the same document, stating some claims were "incorrectly coded" and thus "unlikely to represent claims for treatment with the products described as A9543 and A9545" (Zevalin and Bexxar respectively). Although CMS says it removed these "likely incorrectly coded claims in the ratesetting process," CMS cannot be sure which claims were coded correctly and which were not. Using data that was known to be flawed, the new rate could not have been set accurately.

As many of you know, I received radioimmunotherapy (specifically Bexxar) earlier this year, and it's deeply troubling that this promising therapy may be killed by bureaucracy; more than 500,000 Americans are currently living with lymphoma, and this is the only effective therapy for many who fail standard chemotherapy.

I offered comments during the open period, but now that the ruling is final, no member of the public is able to speak directly to anyone at CMS about the issue. That's why I've contacted both my senators, and asked them to intervene on behalf of lymphoma patients everywhere by telling CMS to reverse its ruling. That's why I'm hoping that you will do the same. It has to be done now, if we're to get this ruling reversed. If not, people will die needlessly. It's that brutally simple.

For more information, please see these links:

Background provided by Patients Against Lymphoma (PAL)

http://www.lymphomation.org/CMS-call.htm#background

http://lymphomation.org/wordpress/?p=14

The ruling is contained in CMS-1392-FC; a draft of the document is available at:

http://www.cms.hhs.gov/QuarterlyProviderUpdates/downloads/cms1392p.pdf