WAMC New England News
10:25 am
Fri January 8, 2010

Blue Cross Vs. Oncology Practices...

Berkshire County – A new policy from Blue Cross of Massachusetts demands that certain cancer medications be purchased from their own pharmacy, instead of patients getting the drugs at the doctor's office. A Berkshire based oncology practice says the new policy puts profit over safety. Our Berkshire Bureau Chief Charlie Deitz reports that the patients could be left out in the cold

Blue Cross/Blue Shield of Massachusetts Chief Physician Executive John Fallon says they are initiating their own health care reform policies by reining in spending on certain cancer medications. Blue Cross says doctors are getting the drugs at bargain prices and billing the insurance companies at retail, so they're taking the drugs out of the equation, "drugs like insulin, a visiting nurse can give the meds, or they can be self-administered" says Fallon.

"That's somewhere between ridiculous and outrageous" says Doctor Harvey Zimbler with Berkshire Hematology and Oncology, or BHO,"We have patients of all different capabilities that need very careful placement of the needle".Zimbler says there's a reason why they choose to purchase their own drugs and administer them on site
"With respect to the drugs on the list these are hormonal agents that need to be mixed in the office under sterile conditions."


Fallon says Blue Cross is only putting a small percentage of cancer medications on the list, and their facilities are sterile and safe "Medications are prepared by specialty pharmacies." Fallon says each dosage could cost hundreds of dollars, meaning hundreds of millions of dollars in annual spending on these medications. He says the patient and the employer who pays for the policy will save money
"This is a state wide and national problem."

Zimbler says the list came out as an edict from Blue Cross, with no dialogue before hand, several oncology practices through out Massachusetts wrote letters to blue cross before the start of this program on January first. Zimbler says there is a profit made on the drugs, "No question there is a small profit, this is a quality practice, you need to make a profit."

So Berkshire Hematology Oncology is fighting back, Zimbler says they will be encouraging their patients to switch insurance providers by the end of the year. Zimbler points out the irony that Blue Cross made this change right after all of their patients signed on for one more year. The clinic which has offices in North Adams, Pittsfield and Great Barrington serves between 100 and 150 patients a day, with about 25 percent of their load carrying blue cross.

Berkshire Hematology is also taking immediate action, Doctor Michael Kaplan is a primary doctor at Lee Family Practice, he says a patient of his came in Thursday morning holding 2 letters. One was from Blue Cross informing them of the medications they would have to get from the specialty pharmacy, the other letter was from BHO advising them that they would not be administering said medications, here's Kaplan " I told them I'd be willing to help but don't have the facilities, or they could go to the hospital."

Kaplan, who also sits on the board for Physicians for National Health are, and is the acting President of the Berkshire District Medical Society, says this is a pure profit issue, and someone is going to have to back down, "The patient is left in the middle, they could change doctors but there's no other providers of services, and the health plan wants them to change."

Which brings up another complicated issue for the patient, trying to find another insurance carrier with a documented, and expensive pre-existing condition. BHO wants to settle this through a dialogue with Blue Cross, but to date, there have been no conversations.