Patients complain Medicare change in drug funding endangers their health

WASHINGTON -- Officially, former tug boat captain Lawrence Michalski died of cardio-respiratory disease last month at his Seminole, Fla., home.

Unofficially, his wife and some doctors say the 67-year-old man died in part because changes in Medicare funding left him scrambling to find a particular drug treatment that many health care providers say they can no longer afford to give needy patients.

The case has become a flashpoint in an argument over thousands of Medicare patients suffering from rare immune disorders and other illnesses that can be treated with intravenous immune globulin, or IVIG.

Immune globulin is a mixture of antibodies, infection-fighting proteins that healthy people normally have in their bloodstreams. It is used mainly by the 50,000 Americans who suffer primary immunodeficiency, 7,000 of whom receive Medicare.

Until recently, most patients could get monthly IVIG treatments at their doctors' offices. IVIG restores the strength of patients whose immune systems are so weak they would otherwise be vulnerable to many infections or illnesses.

After Medicare cut the IVIG reimbursements for doctors from $66 per gram to $39 a gram for powdered brands, many stopped providing the treatment. Michalski and his wife Angelina scrambled to get IVIG from local hospitals, who are slated to get a similar cut next year.

Angelina Michalski said a four-week delay in her husband's IVIG treatment is partly responsible for his death.

Now, doctors who treat such patients are warning that another scheduled cut in IVIG reimbursements, one that would apply to hospitals starting in January, will result in even fewer Medicare patients receiving effective treatment.

"If that happens, a lot of patients aren't going to be able to get IVIG at all, and that will essentially kill some patients," said Dr. Mark Davis-Lorton, director of Clinical Immunology at Winthrop-University Hospital in Mineola, N.Y.

Health advocates first raised alarms in the spring when doctors stopped offering the treatments, arguing they were seeing dangerous shortages.

The Department of Health and Human Services investigated the complaints, and declared in August that there was no shortage. Medicare officials still insist the payment changes have not led to a lack of treatment or scarcity of the drug.

"There are a variety of factors going on in the marketplace, so I don't think you can say the Medicare change in pricing is in itself creating a single reason why individuals say they are not getting their treatment," said Herb Kuhn, director of the Center for Medicare Management.

Part of the problem, Kuhn said, is that IVIG is being used to treat all sorts of health disorders, and that may be siphoning supply away from those who need it most.

Kuhn also said hospitals would not stop offering IVIG treatment once the reduced reimbursement rate goes into effect.

"Manufacturers are working very hard to make sure they're getting the product into the hands of suppliers," said Kuhn, adding that the recent problems with IVIG were a matter of "the market being out of equilibrium," and adding that equilibrium is now being restored.

Rep. Steve Israel, D-N.Y., blamed "an absolutely appalling lack of priorities" in government.

"If we don't stop cutting these Medicare reimbursements, the only people who will be able to afford these treatments will be wealthy people," said Israel, who is trying to rally support in Congress for IVIG patients.

Shirley Peters, a 71-year-old in Palm Beach Gardens, Fla., receives regular IVIG treatments at a hospital for her immunodeficiency, but fears fewer hospitals will offer the treatment next year.

"It's disgusting. What do they expect us to do?" she said. "Are we supposed to just get sicker and sicker until we pass away?"