Best care must come before lower cost

Lewis Musgrove, Las Vegas

Sunday, April 20, 2008 | 2:02 a.m.

The Las Vegas Sun’s Tuesday editorial headlined “A bad policy,” about Tier 4 pricing, which gives the poor and disadvantaged access to lifesaving medicines, reminded me of the plight of prostate cancer patients. Their access to appropriate treatment also hinges on the ability of the patient to pay out-of-pocket expenses.

For years prostate cancer patients have been subject to a bad policy called “least costly alternative.” Targeting only prostate cancer patients, this policy allows Medicare to deny payment for a hormone therapy if a comparable therapy exists that costs less.

So despite the recommendations of a physician, prostate cancer patients may be forced to accept a “comparable” therapy or pay out of pocket for the therapies they need. Because many of the elderly are on fixed budgets, the only option available for some is surgical castration. With the wide range of hormone therapy treatments available, this option represents medicine moving backward.

As a 16-year prostate cancer survivor, I have dedicated my time over these years to helping men who are battling this disease. The last concern a prostate cancer patient fighting for his life should have is a financial hurdle imposed by government bureaucrats in Washington, D.C., preventing him from receiving the medicine his doctor knows is the best treatment option.

I agree with the Sun’s editorial that “health insurance should offer full protection to all who are covered, not simply the healthy.” It is time that “least costly alternative” be abolished.

The writer is chairman of the Nevada Governor’s Prostate Cancer Task Force. The views expressed are his own.