Taxol and health insurance

January 04, 1993

With the Food and Drug Administration's approval of taxol as a treatment for ovarian cancer, health insurers have no justification for refusing coverage of the drug. This fall, about the same time that an advisory panel was recommending FDA approval for taxol, Blue Cross and Blue Shield of Maryland and some other insurers began refusing to pay for taxol treatments they had previously covered. A company official explained that previous payments for the treatment had been made in error. Their grounds? Taxol, the most promising new cancer drug in 15 years, was "experimental."

Technically, they were right. But that rationale is cold comfort for the emotional and financial hardships this bungling caused for patients who had begun a course of therapy assuming they had the support of their insurer.

Taxol, made from the bark of the Pacific yew tree, is the first new therapy in many years to offer hope to women with ovarian cancer, which is particularly deadly because it often goes undetected until it has spread. Each year, 21,000 American women are diagnosed with the disease; 13,000 of them die. A significant number of women whose cancers failed to respond to other forms of treatment showed marked improvement when taxol was administered. Given those considerations, the insurers' actions appear quixotic at best.

This kind of policy-making underscores how bureaucratized, inefficient and, often, inhumane the business of paying for health care has become. If, despite its promise, taxol should not have been covered because it was experimental, then why did insurers ever pay for treatments in the first place?

Once the bean-counters discovered the error, why didn't someone point out the FDA approval process was moving along at an unprecedented pace? Final approval came last week.

Taxol is the first significant drug to be rushed to market by a pharmaceutical company under the Federal Technology Transfer Act of 1986, which authorized Cooperative Research and Development Agreements (CRADAs) between government agencies and private companies. A CRADA partnership between the National Cancer Institute and Bristol-Myers Squibb overcame supply and production problems for taxol and enabled researchers to gather clinical evidence of the drug's effectiveness far sooner than expected.

In contrast to that accomplishment, the clumsy policies of insurance companies appear even more insensitive.

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