High Cost of Cancer Drug Could Bankrupt Ohio Man's Family, 50K A Week: NPR
- 'Nearly $50,000 a week for a cancer drug? A man worries about bankrupting his family,' NPR, Feb. 14, 2023. -Ed.
After several rounds of treatment for a rare eye cancer — weekly drug infusions that could cost nearly $50,000 each — Paul Davis learned Medicare had abruptly stopped paying the bills.' That left Davis, a retired physician in Findlay, Ohio, contemplating a horrific choice: risk saddling his family with huge medical debt, if he had to pay those bills from the hospital out-of-pocket, or halt treatments that help keep him alive.
"Is it worth bankrupting my family for me to hang around for a couple of years?" Davis pondered. "I don't want to make that choice." How much Davis will end up owing for his care remains unclear. One of the hospitals that has administered the costly drug is appealing Medicare's initial payment denials. And the family might not even know their total balance until Medicare rejects all the appeals. * But the uncertainty has compounded the stress of living with an aggressive cancer. Davis, 71, was diagnosed in Nov. 2019 with uveal melanoma, which afflicts eye tissue & is "one of the rarest tumors on the planet," he said. The cancer spread from his eye to his liver, which typically proves fatal within a year.
He was told a new rare-disease drug called Kimmtrak offered the only hope for prolonging his life.
Approved by the FDA in Jan. 2022 as the "first & only" treatment for metastatic uveal melanoma, Kimmtrak has kept his tumors stable, according to Davis. His oncologist told him he should stay on it "until it stops working." Its manufacturer markets the drug's power to deliver "6-month improvement in median overall survival." Davis said he started taking the drug last summer at the Arthur G. James Cancer Hospital in Columbus. The hospital billed a total of $49,367.70 for his intravenous chemotherapy administered on Sept. 13, 2022 – one of his ongoing, weekly treatments. The charge for the drug alone came to $47,838; fees for lab work & for administering the drug accounted for the rest of the bill. Medicare paid the provider & Davis didn't need to pay anything for that week's treatment. His subsequent treatments at the Columbus hospital were covered in the same way, according to Medicare billing statements Davis reviewed.
But things changed after he transferred his care to a hospital in Findlay in October to spare his wife, Jane, from driving him 100 miles each way to weekly appointments in Columbus. Pitted between the hospital & Medicare. Medicare has denied Kimmtrak coverage on claims submitted by Blanchard Valley Health System in Findlay, Davis said, pitching him into an agonizing dispute with hundreds of thousands of dollars in medical bills at stake. After a KHN reporter contacted Blanchard Valley, the hospital connected Davis with a patient relations liaison, who said she is working to resolve the billing problem. Davis said last week that Medicare apparently rejected the claims because the Findlay hospital had made a mistake in the way it billed for the drug; the coding on the bill incorrectly suggested Kimmtrak had been given to Davis for a different type of cancer — one for which its use is not FDA-approved.
Davis said the patient relations liaison told him it might take at least 45 days to straighten out the bill, but the hospital would not dun him, even if it lost the appeal...https://www.npr.org/sections/health-shots/2023/02/14/1156581333/cancer-drug-high-price-could-bankrupt