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Regulators Back Off Plan That Could Have Limited Breast Reconstruction Options

Federal regulators reversed course on a plan that critics said would limit compensation to doctors for performing a complex and expensive type of breast reconstruction called DIEP flap surgery. During the procedure, skin, fat and blood vessels are taken from a patient’s abdomen to surgically create a new breast. The plan by the Centers for Medicare & Medicaid Services (CMS) called for elimination of S codes, medical billing codes that surgeons use to collect more money for DIEP flap surgery than for other, less complicated breast reconstruction techniques like implants or taking muscle tissue from the abdomen. In a June hearing, opponents of the CMS plan argued that the move would make DIEP flap surgery more expensive for patients and that some surgeons would stop offering the procedure if insurers paid less. “The majority of the commenters feel their accessibility will be, or has already been, impacted by the decision to eliminate S codes,” the CMS wrote in reversing its plan. Democratic Rep. Debbie Wasserman Schultz of Florida, a breast cancer survivor who opposed CMS’s original plan, praised the reversal. “This latest CMS decision will provide women with more certainty, and help ensure fair and equitable access to their choice of breast reconstruction techniques,” she said in a statement included in a KFF Health News story. 

US Announces First Drugs Picked for Medicare Price Negotiations

The Biden administration announced Aug. 29 the first 10 medicines that will be subject to price negotiations with Medicare as a way to lower drug prices. Imbruvica (ibrutinib), a kinase inhibitor used to treat blood cancers, is the only cancer drug on the initial list. According to an article in the New York Times, Imbruvica’s cost without insurance is $17,000 per month. The drug was taken by about 20,000 Medicare beneficiaries in a recent 12-month period, according to the Times article. The Centers for Medicare & Medicaid Services targeted drugs that cost Medicare the most, have been on the market for years and do not face competition. Some drugs on the list, like Imbruvica, have a high price tag but are taken by very few people, while others are low cost but taken by large numbers of people. Medicare gained the authority to negotiate drug prices of some prescription medicines as part of the Inflation Reduction Act passed in 2022. Prices negotiated by Medicare are expected to take effect in 2026, but the pharmaceutical industry has challenged the program in court. Stephen J. Ubl, chief executive of the Pharmaceutical Research and Manufacturers of America, an industry lobbying group, called the announcement “the result of a rushed process focused on short-term political gain rather than what is best for patients.”

Research Explores Link Between Cancer Screening and Life Span

A study published online Aug. 28 in JAMA Internal Medicine examined whether six recommended cancer screenings have any effect on longevity for those getting them. Researchers concluded that for five of six tests, there is no difference in life span or the findings are uncertain. The six screening tests analyzed were mammography for breast cancer; colonoscopy, sigmoidoscopy or fecal occult blood testing for colorectal cancer; CT scanning for lung cancer; and prostate-specific antigen (PSA) testing for prostate cancer. The study found that only sigmoidoscopy extended life span, by a little more than three months. Experts who favor screening argued that the study analyzed all-cause mortality, not cancer-specific mortality. “Cancer screening was never really designed to increase longevity,” William Dahut, chief scientific officer for the American Cancer Society (ACS), told CNN. “Screenings are really designed to decrease premature deaths from cancer.” Catching cancer early can allow individuals to undergo successful treatment and live more productive and enjoyable years within their normal life span, Dahut said. “No one’s saying ‘If you do your cancer screenings, you’re going to live to be 100 years old,’” he added. The study authors also urged caution in interpreting their conclusions. “We do not advocate that all screening should be abandoned,” they wrote. “Screening tests with a positive-benefit-harm balance measured in incidence and mortality of the target cancer compared with harms and burdens may well be worthwhile.” Organizations like ACS and the World Health Organization have long argued that routine screening can improve cancer outcomes and that overall cancer mortality worldwide has fallen by one-third since 1991, in part due to early detection via screening.