Patients Dead From Lack of Billing Codes

The most common way patients get off this waiting list it to die … 

(BLOOMBERG) Two months after Gilead Sciences breakthrough treatment was approved to treat a deadly form of blood cancer, only a tiny handful of patients have actually gotten the costly therapy, while others linger on waiting lists.

“There’s no billing codes for this” treatment, says one doctor whose patients are on the waiting list. “It’s been difficult, to be very blunt.”

Five people have received the treatment, called Yescarta, at the 15 cancer hospitals authorized to administer it in the U.S., the hospitals told Bloomberg. Waiting lists for treatment have grown to at least 200 people, shrinking only as some very sick patients have died.

“There’s no billing codes for this…”

Doctors at the cancer centers blame holdups in getting the treatment paid for by Medicare and Medicaid, the two giant U.S. government health programs, as well as some of the U.S.’s largest insurers.

“The biggest issue has been insurance, particularly with Medicare and Medicaid,” said Michael Bishop, director of the cellular therapy program at the University of Chicago Medicine, one of the advanced hospitals that were cleared to administer the complicated treatment. “There’s no billing codes for this. It’s been difficult, to be very blunt.”

Even worse is the cost: $373,000 per patient

Those payment delays, which may not be resolved for months, have forced hospitals to choose between putting millions of dollars at risk, or asking dying patients to keep waiting despite the availability of a potential cure. [PREVIOUSLY ON HEADLINE HEALTH: New Cancer Drug to Cost $373,000]

The delays also mean Gilead is likely to miss Wall Street’s estimates of early sales for Yescarta.

Analysts have predicted the therapy will bring in $9.4 million in 2017, implying about 20 more patients would need to be treated in the next two weeks.

Based on reports by the medical centers doing the billing procedures, that figure seems unrealistically high. (By Michelle Cortez, Caroline Chen, and Natasha Rausch for Bloomberg; full story.)

Also of interest: Pharma Giant to Bill Taxpayers $475,000 Per Patient for New Rx