I just found this board...only to find all you guys from the valuation thread...
I follow GLFD only peripherally because they make the Gliadel wafer and since my husband died of glioblastoma, I try to keep track of new treatments....
I received this letter from a guy who runs the virtualtrials.org website for brain tumor patients...which impelled me to a dig bit into GLFD to find out their CFO just resigned and earnings are out on Monday....
Perhaps this letter will shed some light...not only for GLFD but underscores the happenings at Medicare and patients with different diseases competing for a piece of the finite Medicare pie...just wanted to share in case anyone here might find it helpful....
Another reason I found it haunting is that the brother of a close friend...in his 60's, retired and on medicare was diagnosed last year...was not offered Gliadel...I was quite surprised...
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[....There is a very important issue that will probably pop up later today or
next week, where a grassroots movement can make a huge impact on the lives
of brain tumor patients.
The basic problem is the way Medicare pays for expensive treatments,
like gliadel (and this will apply to a few treatments in the pipeline for
brain tumors also). Instead of saying they won't pay for these things,
which would allow the doctors to give the choice to the patient and allow
the patient to decide if it is worth paying for it themselves, they say
"Yes - we do pay for it". But they do it is a very sleazy manner. They
say that it is include in the payment made to the hospitals for the brain
tumor surgery.
For example, if you have a brain tumor operation in the hospital, the
hospital gets paid around $50,000 (it varies by location and other
problems
a patient has, but I will use these numbers as an example). That includes
the use of the operating room, recovery room, ICU, and hospital room, as
well as the staff needed to run it - for as long as the patient stays in
the hospital. If you stay 1 day or 10 days, the payment doesn't change.
Sounds like a lot of money, but it barely covers the costs if the patient
stays for 2 days and the hospital loses money if the patient stays for 3
or
more days. (Which is why a typical stay was 7 days 10 years ago and is now
about 3 days for a brain tumor operation) Now they are throwing Gliadel
into that also. If the doctor inserts the gliadel wafers, the hospital has
to pay for the drug, about $12,000. BUT they do not get any extra payment
from medicare, so in effect, it costs the hospital $12,000 every time they
use gliadel. The worst part is that since Medicare is "paying" for it,
the
patient is not even allowed to pay for it even if he wants it. The choice
is being removed from the doctor and patient all together. The hospitals
are pressuring the doctors not to use it and not even mention it as an
option to the patients.
I had a meeting with the Medicare people about this. Their response
was that the way the hospital payment system is set up, hospitals make
money on some procedures and lost it on others and it all evens out in the
end. What they couldn't understand is that it adds an economic incentive
to withhold a treatment option. Medicare told me that no hospital or
doctor would let the economic pressure cloud the decision. I talked to
doctors who told me that they are forbidden to use gliadel on a medicare
patient, and are threatened with being thrown off staff if they use it.
Net
result: only about 5% of the medicare patients who were probably eligable
for using gliadel got it last year.
Latest research on gliadel shows a 25% decreased risk of death at the 3
year mark.
Later today or next week, Medicare is going to publish the results of my
meeting as a proposed rule. I have no idea what it is going to say, but in
any event, that opens up a public comment period. We need to generate a
huge amount of support to influence this to go our way. We (the drug
company, as well as a few of the biggest neurosurgeons in the country were
with me) asked for a new code to use when a treatment device is inserted
into the brain at the same time as a brain tumor surgery. This would pay
for gliadel as well as the next generation of devices coming down the
pipeline. We are fighting against other special interest groups who are
also fighting for the same thing for what they feel is important. The
total
number of dollars that medicare has is constant. What is happening is a
reshuffling of how it is spent. If we get what we want, someone else has
to
lose. If someone else gets what they want, we can lose. I talked to the
person in charge of this and she told me that they bend to public opinion.
They want to help the most people on the money they have. She said we need
10,000 letters to even have a shot at making a difference, and that we
should do this no matter what the proposed rule says - even if it is in
favor of the new code - since other groups will be fighting for what they
want also.
Al |
