Wednesday, May 23, 2001

Insurance providers might not cover drug

By Tim Bonfield
The Cincinnati Enquirer

        As exciting as Gleevec may be, the new drug from Novartis Oncology may cause financial hassles for people who need it.

        Because the drug is so new, and because it's in pill form, it may not be covered by private or other insurance.

        For people under 65, the drug may not yet have been added to many commercial health plans' coverage lists. That depends on the insurer.

        For people over 65, Medicare typically pays for chemotherapy administered through an IV. But Gleevec is a pill. And Medicare does not cover outpatient prescription drugs.

        To get drug coverage, seniors must buy supplemental plans, join Medicare HMOs or be poor enough to qualify for Medicaid. Otherwise, families face paying out-of-pocket for Gleevec — currently up to $2,400 a month — indefinitely.

        To help patients sort through coverage details, Novartis has set up a reimbursement hotline: 1-877-GLEEVEC. The company also offers a patient assistance program for some uninsured people.

        The Leukemia & Lymphoma Society also is providing consumer information about Gleevec through its Information Resource Center, 800-955-4572.

        Meanwhile, the society plans to pressure Congress to act on Medicare prescription-drug coverage.

        “New oral drugs are becoming an important part of cancer therapy,” said George Dahlman, the society's vice president of public policy. "And government policy needs to keep up with medical progress. Medicare currently will not cover oral drugs unless they are versions of intravenous drugs. That does not make any sense.”


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