Medicare No Longer Covers Brain Cancer Drug Gleostine, Which Costs Up to $1K Per Pill; How to Cover Prescription Costs After a Claim is Denied

Published Jun 17, 2021

Chris Spargo

Medicare will no longer offer prescription coverage of the brain cancer drug Gleostine after the company that produces the medication made the decision to exit the national health insurance program.

The Wall Street Journal reports that NextSource Biotechnology LLC pulled out of the federal program at the beginning of the year, making Gleostine ineligible for the Part D benefits which offset the cost of the medication which can run as high as $1,000 for a single pill.

Gleostine has proven effective in helping to treat patients with glioblastomas, the aggressive brain cancer which claimed the lives of former senators John McCain and Ted Kennedy, President Biden’s son Beau Biden and Broadway star Ethel Merman. There are currently less than five FDA-approved drugs which are similar to Gleostine on the market today.

NextSource Biotechnology LLC has pointed out in the past that the company provides Gleostine at a “significantly reduced cost to uninsured patients and patients who lack the resources to pay for the product.” The drugmaker also said in a statement that Medicare patients meeting certain income criteria have been receiving Gleostine at no cost since the first of this year under a patient-assistance program that is offered by the company.

Furthermore, NextSource said that it has not denied any applications seeking financial assistance to cover Gleostine while it reevaluates its participation in the Medicare program.

RELATED: REMEMBERING BEAU BIDEN SIX YEARS AFTER HE LOST HIS BATTLE WITH BRAIN CANCER

A dose of Gleostine can cost anywhere from just under $100 to just over $1,000 per pill depending on its size. Patients typically take the medication every six weeks. It is also used in the treatment of Hodgkin’s disease and other forms of brain cancer.

What To Do If You Can’t Afford Your Medication

“There’s a term, ‘financial toxicity,’ that we use, along with describing other toxicities of cancer therapy,” Dr. Kris Zanotti, gynecologic oncologist at University Hospitals in Cleveland, Ohio, previously explained in an interview with Survivor Net. “Financial toxicity is real, and it’s associated with poor quality of life and poorer cancer outcomes.”

If an insurance company denies a claim for a treatment your doctor recommends, your doctor then has to find another treatment option, or begin an appeal process. This is particularly an issue with newer and more aggressive treatments, such as PARP inhibitor drugs.

RELATED: ARE TREATMENT OPTIONS FOR BRAIN CANCER PROGRESSING?

If your doctor believes this treatment will benefit you and is the best available option, they can create a case to appeal to your insurance company for coverage. The appeal will argue that the treatment is medically necessary and that it will benefit you. “The clinician will then present evidence for it and undergo an appeal process that may take one week to fourteen days,” said Dr. Zanotti.

If that doesn’t work and the insurance company continues to deny the claim, a compassionate use program may be a good alternative. A good place to begin is with the Food and Drug Administration Compassionate Use Resources page. Many pharmaceutical companies have programs that provide medication or testing free of charge for patients in need. As long as your doctor can demonstrate that you are receiving continued clinical benefit from the drug, these programs can sometimes meet the entire cost of treatment.

Navigating the costs of cancer treatment can be stressful, and may be hard to do alone. A social worker and financial counselor at your cancer center can help you determine what your insurance company will cover, and how to pay for any costs that remain.

New Treatment Fights Brain Cancer With Electric Fields

A new, novel treatment for glioblastoma is extending life for some people with this disease.

“There’s been a very exciting development of tumor treating fields, which are electrical fields that have been applied to the brain,” Dr. Suriya Jeyapalan, a neurologist at Tufts Medical Center told Survivor Net in a previous interview. In practice, “they’re basically these adhesive pads that connect to a device … and it generates this alternating electrical current.”

At its most basic level, cancer is the uncontrolled divisions and replication of cells. A company called NovoCure developed the tumor treating field technology, which works by disrupting the division of cancer cells and, in some patients, delaying the progression of the cancer. Optune, the brand name for the tumor treating fields delivery system, was launched in 2011 and approved by the Food and Drug Administration (FDA) in 2015.

Tumor-treating fields, in combination with standard treatment, have added two years to the median survival rate for glioblastoma in about half of patients who use it and five years of additional life for about a third of patients. Because the technique is so new and novel, there is still no data on how effective tumor treating fields are in the long term. But Dr. Jeyapalan says the results of this new treatment should give people facing a brain cancer diagnosis hope. And, for a disease where only 9.8% of people are alive five years after diagnosis, hope is an enormous thing.

As a note of disclosure, one of SurvivorNet’s founders previously served on NovoCure’s board of directors.

Contributing: James Roland

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Chris Spargo is a senior reporter at SurvivorNet. Read More