Procrit The Facts
This article is a rebuttal to the Wall Street Journal article on “the misuse of Procrit” by oncologists across the country. The article claims that oncologists across the country misuse Procrit to make “lots of money.”
Let us look at the facts Procrit (erythropoietin) is a medication that stimulates the bone marrow to increase the production of red blood cells. The indications for the drug are anemia due to chronic kidney disease, anemia in HIV patients on zidovudine, anemia due to chemotherapy in patients with cancer, and for reduction of allogeneic red blood cell transfusions in patients having elective non cardiac, non-vascular surgery.
In 2007 strict administration guidelines were implemented by Medicare stating that in renal patients it could be given only if the hematocrit <36 and hemoglobin <12, and for cancer patients if the hematocrit <29 and hemoglobin <9. When Medicare is billed the level of hemoglobin or hematocrit must be submitted with the billing charges for reimbursement.
The total reimbursement for Procrit 10,000 units injection allowed by Medicare is $112.72 and 80% of this figure is paid by Medicare $89.81. The remaining 20% is paid by the patient, or if the patient has secondary insurance, $22.91. The cost for one box of six injections of Procrit is $667.85, which means that one dose of Procrit 10,000 unites costs $111.30 which means our great “profit” claimed by the Wall Street Journal is $1.42 per injection.
The other FDA approved injection of erythropoietin is Aranesp. One dose of 100 micrograms of Aranesp costs physicians $369.91. Medicare allows for reimbursement of $328.07. Again, 80% is paid by Medicare, or $262.45. The 20% is $65.62, which is the responsibility of the patient, or if they are fortunate to have secondary insurance. Which means $41.84 is not covered and is a loss to the physician.
Because these medications have made a huge difference in patient health and quality of life, my practice goes through specialty pharmacies that bill the patient's insurance directly and relieving the patient of out of pocket costs if possible. What is not mentioned in the article either is from the time the charge is billed, reimbursement can take 30-60 days. Another advantage linked to the administration of erythropoietin products is a marked decrease in the need for blood transfusions.
It was also stated that giving erythropoietin to cancer patients could worsen their, prognosis which was based on few very small studies that were inconclusive. As far as the risk of stroke the hemoglobin and hematocrit would have to be extremely high and this does not happen if guidelines are followed.