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12:00 AM
Mar 17, 2003
 |  BioCentury  |  Regulation

OPPS blocking access to drugs

Patients have been denied life-saving cancer therapies as a result of the government's new Medicare reimbursement system, biotech companies and healthcare providers told Congress last week.

With the outpatient prospective payment system (OPPS) in place only since Jan. 1, only a small number of patients have reported that the reimbursement scheme has caused hospitals to turn them away. But hospitals haven't yet realized that they are losing money under OPPS because of the time lag between when they receive bills and when they are reimbursed, according to industry executives and physicians. They predicted that the number of complaints will swell as more hospitals realize that they are losing money every time they administer products like Rituxan rituximab or Zevalin ibritumomab tiuxetan radiolabeled antibody.

The early examples of the negative effects of the OPPS rule were presented at a congressional briefing organized by the Biotechnology Industry Organization (BIO) and the California Healthcare Institute, which are leading a coalition that is pressing to repeal and replace the OPPS rule (see BioCentury, Feb. 17).

"Many of our patients can no longer get our products in the hospital outpatient setting," said Myrtle Potter, executive vice president of commercial operations and COO at Genentech Inc. (DNA, South San Francisco, Calif.).

DNA markets Rituxan with Idec Pharmaceuticals Corp. (IDPH, San Diego, Calif.) to treat non-Hodgkin's lymphoma (NHL). Because Medicare is paying less than the acquisition price for Rituxan and DNA's Herceptin trastuzumab breast cancer drug, some hospitals are refusing...

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