I was searching the web for info on the best way to give epo in home programs when i came across this series of posts:
"Kidney News : Taxpayers Take it On the Chin For Amgen!
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From: Dialysis Joe (Original Message) Sent: 10/27/2006 9:59 PM
Editorial on The Administration of Epoetin Alpha By Joe Atkins, RN, MBA, CNN, CHT
There can be no doubt that Epoetin Alpha, a drug produced by Amgen, Inc., has made life easier for dialysis patients, as well as dialysis providers. But, should any single drug consume 20% of Medicare’s dialysis budget?
Few people realize that, out of the $10 billion dollars that Medicare pays for dialysis treatments for 300,000 dialysis patients, $1.75 to $2 billion dollars of that money goes for a single drug, which is Epoetin Alpha. Epoetin Alpha is a drug that replaces the blood building hormone normally produced in healthy kidneys. Without this hormone, patients with kidney failure cannot build new red blood cells and, therefore, become severely anemic, requiring regular blood transfusions.
What concerns me is that Medicare and commercial insurance companies could reap savings in the hundreds of millions of dollars, each year, if Epoetin Alpha were administered subcutaneously. It’s unfortunate that, presently, most dialysis providers have chosen to administer this expensive drug, intravenously, which is the least effective and most costly way to administer the drug.
In 2002, the Department of Internal Medicine, University Hospital, in Uppsala, Sweden carried out a study where they switched from subcutaneous administration of Epoetin Alpha, to intravenous. What they discovered was that the change to IV administration required them to increase the dose of the drug by 15% in order to maintain the same effect that the patients had achieved, with their subcutaneous administration. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16118109&dopt=Abstract
What the Swedes discovered concerning the economics and efficacy of the subcutaneous administration of Epoetin Alpha is old news. The entire ESRD provider community around the world is aware of studies that have proven this fact. So, the question is, why are we still giving this expensive drug, IV?
The sad answer to the question, above is profit. Profit for the providers and profit for Amgen, Inc. When you are talking about billions of dollars, a 15% savings is pretty significant. And, in my opinion, this savings could be significantly higher than 15%.
So, why isn’t Medicare doing anything to encourage providers to administer the drug subcutaneously, as opposed to intravenously? They seem to have no problem mandating the Fistula First program in order to reduce the numbers of central venouls lines being used by dialysis patients. What could be holding them back?
Since 1999, I’ve personally written and called the Inspector General of the United States, and the IG of Health and Human Services over a period of five years, with no action taken on this very issue. I wrote Senator Mike DeWine, who is a member of the Subcommittee on Antitrust Competition Policy and Consumer Rights, as well as Senator George Voinovich, Congressman Mike Turner, as well as President George W. Bush, explaining how intravenous administration of this expensive drug is causing a burden to taxpayers. All I received, from any of them were form letters, some of which didn’t even relate to the subject at hand.
It’s clear to me that our good polititians from Ohio really don’t care how much waste and corruption is costing tax payers. Medicare Part D, which is a no bid, pay full retail hand out to the pharmaceutical industry is a real clear indication of how our polititians in Ohio and in the Whitehouse have prostituted themselves out for campaign contributions. They’re whores and there’s just no civil way to put an decent spin on it. They’ve sold out the American taxpayers.
Well, Mike DeWine, George Voinovich, Tony Hall/Mike Turner (two consecutive Representatives from the same Ohio district, one Democrat and the other a Republican), George W. Bush and the OIG can’t say that they weren’t told about the abuses going on with EPO administration. They were all told, repeatedly, over and over, again, since 1999. Their choice was to sit on their hands, do nothing, and let the pharmaceutical industry support their campaigns, at taxpayers expense.
This has become an ugly little secret in the ESRD provider industry, which really has never been a secret, at all. Everyone in the industry has winked at this evil and turned a blind eye. Every person who has sit on their hands and said nothing is guilty. Just as guilty as those making billions of dollars at taxpayers’ expense.
The saddest thing about the abuse of Epoetin Alpha is that SC vs IV administration is only the tip of the iceburg. Over time, more and more is going to be revealed, which will show how the industry has quietly worked together to maximize the use of Epoetin Alpha, in every possible way, and all for profit. The conflict of interest among those setting the standards for EPO guidelines and administration is ridiculously obvious and is a blight on the entire ESRD industry.
Maybe it’s time to reach inside ourselves and rediscover why we got into this business in the first place. At one time, it was about helping people get better. Now, it’s just about the bottom line.
We can all blame “The System” for causing us to do the things we do, or, we can take personal responsibility for our actions and make the right changes in the way we provide care, and do business. A great place to start would be switching every patient, all 300,000 plus ESRD patients, to subcutaneous administration of Epoetin Alpha.
Just think about this, $2 billion dollars is two thousand million dollars. Even at a modest 15% savings from sucutaneous administration of Epoetin Alpha, this results in a savings of $300 million dollars. And, that’s just for Medicare. That doesn’t count the money being paid out by private insurance providers, who, by the way, are really getting hosed. No one in the insurance industry has put those numbers together, but you can be assured that it’s considerable. Most insurance providers are paying six to ten times what Medicare pays for each dose of Epoetin Alpha. I can hear the presidents of Aetna, Anthem and United Healthcare choking on their champain and caviar, right now.
Joe Atkins, Managing Editor
Dialysis & Transplant City"
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I can activate her right away, just give me moderator status and every legit person awaiting activation I can handle swiftly, am nearly always available over the net. With my other net projects it just keeps me close here…