Friday, August 16, 2013


The FEHBlog had anticipated that the "Congress in the healthcare exchanges" kerfuffle would be resolved by a combination of a Congressional appropriation to reimburse staffers a share of their exchange premiums (likely using the FEHBP fair share formula) and an OPM rule explaining the exchange coverage will count toward the five years of FEHBP coverage immediately before retirement required to carry FEHBP coverage into retirement. That's not what happened of course. 

OPM decided to treat exchange plans are FEHB plans and make the government contribution on that basis. A surprising twist in the proposed rule is that while OPM does allow exchange coverage to count toward the five year requirement, the members of Congress and official staffers will have to receive their annuitant coverage in the exchanges. However, the exchanges are designed to cover people over 65 with Medicare coverage. That could change in the final rule.

The West Virginia Gazette reports that West Virginia Congresswoman Shelley Capito plans to refuse the Government contribution for exchange coverage and introduce a bill blocking members of Congress from receiving the Government contribution.  She could be a trendsetter.

A new political twist is that the OPM rule has generated an abortion coverage debate as explained in the AP story. Go figure.

The Wall Street Journal had a very encouraging story earlier this week about targeted cancer therapies. The article explains that just 10 years ago, doctors recognized two types of lung cancer -- small cell and non-small cell. Now researchers have identified 15 genetic mutations representing 65% of lung cancer cases.  Drug companies are working furiously on targeted therapies to fix these mutations. The article discusses a 41 year old woman who was given three months to live in 2010 due to a lung cancer that had spread to her brain. Her doctor discovered that she has an indentified genetic mutation for which a targeted therapy exists. She is still alive today although long term effectiveness of the fix is not guaranteed. The article concludes that
Tests for mutations are less likely to be available in smaller doctors' offices. Even many large centers are just putting in place systems to act on the information. "A lot of places can tell you they do this now, but few really have the people in place who know what to do," says Roy Herbst, chief of medical oncology at Yale Cancer Center, New Haven, Conn., who is Ms. Carey's current oncologist.
But rapid diagnostic advances are making it easier for any doctor to test for the newfound cancers. Tests now can hunt for more than 200 mutations—of lung and other cancers—in one biopsy.
Evidence that precision medicine works will likely broaden its use quickly. A June 2013 report on 1,007 patients with advanced lung cancer whose tumors were sequenced by a group of researchers called the Lung Cancer Mutation Consortium found that 62% had alterations suspected of being driver mutations.
The researchers reported that the 265 patients on the study treated with a targeted drug had a median survival of 3.5 years from diagnosis, compared with 2.1 years for the 361 patients for whom a mutation wasn't identified.
"It opens up so many more doors for patients if you can find their target," says Alice Shaw, an oncologist at Mass General in Boston.

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