The Daily Rise: Friday, April 22

Cancer Doesn’t Make Us Worth Less

Anyone considering support for the Institute for Clinical and Economic Review’s value framework must read a powerful piece by our friend Jennifer Hinkel, a cancer survivor and health economist.

For those who haven’t been following the issue, ICER is working to establish an economic formula that would ultimately be used by health insurance companies and government programs to deny treatments for some patients. The framework will rank medications for a blood cancer called multiple myeloma even though these same medications have resulted in great strides toward making this incurable cancer a chronic, manageable disease.

“I’m a cancer survivor, and I take enormous offense at the suggestion that at any point in my life, I might have been worth less than one,” Hinkel writes at “An economic formula that counts sick people as fractions could ration health care and penalize cancer patients.”

She adds, “If allowed to continue, ICER could provide American insurance companies a basis to deny coverage for drugs, dis-incentivize investment in cancer science, and leave patients facing the equivalent of some much-ballyhooed “death panel” for the rationing of their health care.”

Hinkel makes a powerful case against ICER’s framework and what it means for patients.

“The ivory-tower methodologists at ICER are putting all of us — past, current, and potential future patients — at risk with their academic, vaguely patriarchal methodology that seeks to say who is “worth it” and who is not,” she writes.

Take Action

After you read Hinkel’s piece, which eviscerates ICER’s framework, take action. Medicare is considering using ICER as a benchmark for policy; you can publicly comment on that proposal by May 7 at this link, and by clicking “Submit a Formal Comment”.

State Spotlight: End Fail First in Ohio

Insurance companies are fighting a proposal to end “fail first” policies in the Buckeye State. Known by the more innocuous “step therapy,” these policies force patients to receive ineffective but lower cost treatments before gaining access to the right treatment prescribed by their doctors.

The Plain Dealer’s Casey Ross shares the story of Cheryl Volk, a nurse who found a treatment that worked to cure scaly blotches of red skin. After her doctor prescribed the right treatment that worked, her insurance company overruled her doctor and forced her to switch to an ineffective treatment.

“My heart sank,” the intensive care nurse told the Plain Dealer. “I knew it was going to come back, and my doctor knew it, too.”

Now, she’s fighting back against fail first by offering her testimony to the Ohio State Legislature in support of legislation to limit “fail first.”

“This is particularly problematic when you’re dealing with mental health medications,” explained State Senator Peggy Lehner, a co-author of the bill to limit fail first. “Lots of those drugs take three or four weeks to kick in. If you have to go through two or three different drugs, you could be talking months of delays before getting the drug the doctor felt was going to work best for you.”

Enjoy with Your Weekend Coffee

This weekend, take the time to read Vann Newkirk’s lengthy piece published at The Atlantic on the cancer moonshot initiative and the potential for landmark breathroughs in cancer treatments. Here’s a short excerpt to pique your interest.

“Radical new advances in science provide hope that seemed impossible before, and newly developing partnerships among public entities, private companies, academic researchers, patients, and insurers provide a staging ground for that science to take off. In this instant, there might finally be a window. Maybe the moon isn’t as far away as humanity once thought?”

Trimodal Therapy

Half of patients with rectal cancer are receiving substandard care, reports Kay Jackson, a contributing writer for MedPage Today.

National guidelines establish that the best treatment for rectal cancer is to use neoadjuvant chemoradiotherapy, surgery and adjuvant chemoradiotherapy. Following these guidelines, patients have a 5-year survival rate of 72.4%.

When the guidelines aren’t followed, the 5-year survival rate for patients that receive surgery alone drops to 44.9%.

“Trimodality therapy is associated with the best outcomes for these patients, and surgery alone or definitive CRT should only be reserved for patients who are unable to tolerate trimodality therapy, or for carefully selected patients taking part in clinical trials,” Timur Mitin, MD, PhD, of Oregon Health and Science University in Portland, and colleagues wrote in their study published online in the journal Cancer.

All patients should gain access to the treatment that is right and most effective for them.

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