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Medicare cost-cutting: Prostate treatments come under controls

Zoladex, top. is less expensive than the more popular Lupron  
December 15, 1998
Web posted at: 1:07 p.m. EDT (1707 GMT)

From Reporter Louise Schiavone

(CNN) -- In the fight for survival, patient and doctor become a team. And many don't appreciate Medicare's involvement with a new policy called "least costly alternative."

"Don't come in between my relationships with my patients," said oncologist Dr. Steven Strum. "It's not right; it's not reasonable; it's not part of your skills to tell me how to practice medicine."

Strum practices medicine in California, where Medicare providers are considering a plan to limit payments for a class of prostate cancer drugs. The two drugs are Lupron, about $500 per dose, and Zoladex, about $390 per dose. Medicare wants Zoladex, the cheaper drug, used.

Medicare patients who prefer the more expensive, and more popular, Lupron would have to pay the cost difference.

"I usually take it in the hip, whereas Zoladex is a larger bore needle and it's usually given in the abdomen," said prostate cancer patient Fred Mills.

Medicare says that while Lupron is slightly easier to administer, the results from Lupron and Zoladex are the same.

"Zoladex is a pellet that's placed underneath the skin," said Dr. John Lynch, chief of urology at Georgetown University Hospital. "I think that patients probably have some concern or fears about the size of the pellet or the discomfort associated with it.

"But it is perfectly acceptable and it is an acceptable form of treatment," he said.

Last year, Medicare spent $515 million on Lupron, compared with about $106 million for Zoladex. This reflects not only price difference, but patient preference.

Dr. Jeffrey Kang of the Health Care Financing Administration says the campaign to control costs is safe and reasonable.

"If a physician shows that there is a medical reason why a patient can't take Zoladex, Medicare will cover the higher Lupron payment," he said.

This particular cost-cutting measure is already in effect in about a dozen states. And it's the first time medication, as opposed to medical equipment, has been subject to Medicare's cost-control policy.

The question is whether more drugs will come under the cost-cutting controls. It's possible since there is some evidence the policy may be forcing prices down. Lupron is now less expensive than before in some areas.

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