Insurers stop paying for taxol Ovarian cancer drug lacks FDA approval

December 19, 1992|By Jonathan Bor | Jonathan Bor,Staff Writer

Victims of ovarian cancer who are pinning their last hopes on the experimental drug taxol are suddenly fighting not just their disease but the refusal of insurance companies to cover costs of administering the drug.

In Maryland, many doctors and patients say they are angry that Blue Cross and Blue Shield of Maryland and other smaller insurers suddenly began in October to refuse to pay for taxol after more than a year of approving claims.

Some companies, including Blue Cross, even began to ask some patients to return money paid for past treatments, saying in letters that the reimbursements were made in error.

Doctors and patients say they are perplexed that companies began to refuse taxol coverage around the same time the National Cancer Institute decided to make taxol more widely available.

A Blue Cross official said the refusals had nothing to do with the institute's action and were based simply on taxol's status as a drug that is still in the experimental stage.

Jim Witeck of Centreville, Va., said Maryland Blue Cross covered three taxol treatments at Johns Hopkins Oncology for his wife, Carol Witeck, 44, before refusing in October to pay for her fourth treatment. The couple paid $2,000 so treatment could continue.

"I had no choice," he said. "I was trying to save her life. What frosts me is that they covered three and that creates an expectation, right or wrong."

The treatments seemed at first to shrink her tumor, which had grown into her abdomen, but subsequently lost their effect. She now receives hospice care at home.

"It could be tomorrow, or a month from tomorrow," he said. "She's just too damn young to go, and I didn't need all this from Blue Cross. It was time to focus on ourselves and our situation."

In October, the cancer institute ruled that doctors in private offices across America could administer taxol, a relaxation of rules that had limited treatments to regional cancer centers such as Hopkins. The change was based on the institute's view that the drug had cleared many experimental hurdles and was all but assured of final approval by the Food and Drug Administration.

A month later, an FDA advisory panel recommended that the agency approve taxol as a standard treatment for ovarian cancers that have failed to respond to at least two other chemotherapy agents.

Observers predict that the FDA could approve the drug as soon as next month, but some doctors argue that patients with large tumors could die or suffer needlessly if forced to wait.

Taxol is not considered a cure but a way to alleviate symptoms and give patients additional months of life.

The about-face by insurance companies prompted Hopkins to ask patients for a $2,000 deposit if they lack authorization for coverage. New patients who can't meet the out-of-pocket expense risk being turned away, although Hopkins officials say they are doing their best to accept the women while attempts are made to resolve the dispute.

"I think this is the wrong drug and the wrong disease to make a stand since this is an active treatment for ovarian carcinoma," said Dr. David S. Ettinger, clinical director of the Hopkins Oncology Center. "I think it's disgusting."

The drug itself is being provided free by the manufacturer, Bristol-Myers Squibb of New York, but hospitals charge an average of $2,000 for each treatment for physician and nursing services and other costs associated with administering taxol. It is given in a 24-hour infusion, requiring an overnight stay.

Patients may need three to six treatments.

Dr. Ettinger said he was surprised that Maryland Blue Cross would make an issue over taxol -- a drug that offers hope for one of the deadliest of cancers -- at a time when the company has come under intense scrutiny for what critics call a history of financial losses, poor management and shoddy service.

Denise Noll, director of managed medical services for the Maryland insurer, said the refusals are based on contractual language that obligates coverage only of drug treatments approved by the FDA. "Taxol is not yet at this stage," said Ms. Noll, a registered nurse. "If benefits had been provided by us, then they were benefits provided in error."

She said the decision to deny coverage resulted from an internal review of payments that took place, coincidentally, around the time the institute widened taxol's availability. The denials, she said, were not motivated by a desire to save money but were based on a policy against supporting unproven therapies.

Historically, insurance coverage for experimental treatments has been spotty at best in Maryland and elsewhere. But the cancer institute issued a position paper earlier this year recommending insurance coverage of taxol because, in its view, the drug had shown great promise.

The agency, however, cannot dictate policy to insurers.

This year, it is estimated that 12,000 patients will die of ovarian cancer. It is a particularly serious cancer because it often goes undiscovered until it is too large to control. Cancer centers are administering taxol at a rate of 4,000 patients a year, according to the cancer institute.

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