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Biotech / Medical : IDPH--Positive preliminary results for pivotal trial of ID -- Ignore unavailable to you. Want to Upgrade?

To: Pseudo Biologist who wrote (1422)	1/15/1998 4:52:00 PM
From: Maurice Winn	Read Replies (1) \| Respond to of 1762

PB, Don't people buy an insurance policy, read the fine print, and if Rituxan is in the contract, then they get the treatment paid for? I suppose there are plenty of grey areas where treatment isn't clearly within the ambit of the contract so some dispute can arise. While admitting ignorance on the matter, wouldn't it be true that as soon as efficacy is shown, most health insurance policies would require payment for the treatment? I don't see why people would buy a policy which excluded treatments which are successful on a significant proportion of patients. Personally, it seems a better deal to simply save your money, invest it, then if you need medical treatment, buy it. Why pay insurers, people careless of their health, fraudulent claims, taxes on insurance? Put all that money towards your own health savings scheme. But I know most people love insurance and prefer others to manage their affairs. My quandary as a pay-or, is that the doctors are indifferent, saying since there is no clinical evidence, for other than on-label applications, there is no point using Rituxan for other CD20 problems [namely intermediate grade, large diffuse cell lymphoma]. Anyway, government wheels move slowly on approvals in New Zealand. I guess the big market is the USA, but there is a little point of view from a prospective customer. Wanting to pay, but nobody wants the money. So IDPH profits are less than they should be in my opinion. Maurice

To: Pseudo Biologist who wrote (1422)	1/15/1998 8:00:00 PM
From: Scott	Read Replies (2) \| Respond to of 1762

PseudoB, While my doctorates do not include an M.D., I've sat in on a lot of high-level meetings on drug reimbursement, strategy and deciding what indication(s) to do clinical trials on. I'm not an expert in this area, but it seems to me that the "payors" do not balk at reimbursing off-label uses of drugs as long as the use is relatively mainstream. If they can justify their holding back as protecting their constituencies, since the use is "experimental" (read very expensive and they think they can get away with this), they will. But if a drug use is reasonably related to the approved indication, I do not know of any hesitancy to cover it. In fact, the majority use, certainly reimbursed, of quite a few prescription drugs is not label indications. For example, up till this year Prozac was only approved for major depression and obsessive-compulsive disorder, but hundreds of thousands of people with other problems were routinely getting it as the most mainstream treatment for conditions like eating disorders, panic disorders, etc. And I've never heard of reimbursement problems. Another: most major antibiotics are not approved for treating more than several specific bugs, but docs use them all the time for off-label treatments. Ex. Metranidazole is a major treatment for H. pylori, but that was never an approved indication. I could go on. I don't think Idec is very worried about reimbursement for major off-label uses of Rituxan.