Patient on $50,000-a-Week Cancer Drug Fears Leaving Behind Huge Medical Debt

After several rounds of treatment for a rare eye cancer—weekly drug infusions that could cost nearly $50,000 each—Paul Davis learned Medicare had abruptly stopped paying the bills.

That left Davis, a retired physician in Findlay, Ohio, contemplating a horrific choice: risk saddling his family with huge medical debt—if he has to pay those bills from the hospital out-of-pocket—or halt treatments that help keep him alive.

“Is it worth bankrupting my family for me to hang around for a couple of years?” Davis contemplated. “I don’t want to make that choice.”

Uncertain how much Davis will end owing for his care. One hospital that administered the expensive drug is appealing Medicare’s initial payment denials. The family might not be able to see their balance until Medicare rejects all appeals.

However, living with aggressive cancer has made it more stressful.

Davis, age 71, was diagnosed with uveal melanomas in November 2019. This is a condition that affects the eye tissue and can be fatal. “one of the rarest tumors on the planet,” He stated.

He had cancer that spread from his eye to the liver. This is usually fatal in less than a year. He was told a new rare-disease drug called Kimmtrak He was offered the only chance to prolong his life.

Approved and approved by the U.S. Food and Drug Administration. in January 2022 The “first and only” According to Davis, Kimmtrak was used in treatment of metastatic uveal carcinoma. His oncologist recommended that he continue to take the drug. “until it stops working.” The drug’s manufacturer sells the drug’s ability to deliver “six-month improvement in median overall survival.”

Davis claimed that he took the medicine last summer at Columbus’ Arthur G. James Cancer Hospital.

For his intravenous chemotherapy, which he received on September 13, 2022, the hospital charged $49 367.70. The charge for the drug came to $47,838—the rest covered fees for lab work and administering the drug. According to Medicare records, the provider was paid $11,668.86 by Medicare for these services.

The Medicare billing statements Davis reviewed also indicated that his subsequent treatments at Columbus hospital were covered.

However, things changed after he transferred to Findlay hospital for his care in October. Jane was able to drive him 100 miles to Columbus weekly appointments.

Davis stated that Medicare denied Kimmtrak coverage for claims filed by Blanchard Valley Health System, Findlay. This has led Davis to an intractable dispute with hundreds of thousands in medical bills.

Blanchard Valley was reached by a Kaiser Health News reporter. Davis was then connected to a patient relations liaison who is currently working to fix the billing issue. Davis claimed last week that Medicare rejected the claims after Findlay hospital incorrectly invoiced for Kimmtrak treatment for another cancer.

Davis said the patient relations liaison told him it might take at least 45 days to straighten out the bill, but the hospital would not demand payment, even if it lost the appeal.

Kimmtrak charges are still being assessed. “are in limbo,” Davis said.

Amy Leach was the hospital’s director for public relations. She said that she could not comment on Davis’ case, but she did send an email: “Blanchard Valley Health System is committed to ensuring that accurate billing occurs and we work with our patients to promptly resolve any concerns.”

Stacie Dusetzina is a Vanderbilt University Medical Center expert in drug pricing and health policy. She said that Davis has every right to be concerned.

“I hope the hospital will fix this for him and that they are communicating with him about it,” She spoke.

Sebastien Desprez spoke for Oxfordshire-based Immunocore which makes Kimmtrak. He stated that the list price of the drug was $19,229 per week. He stated that the FDA approved the drug. “there is value for patients.”

Cancer drug prices “are outrageous,” Dr. Hagop Kantian, who is the chair of the Department of Leukemia at MD Anderson Cancer Center (Texas), said that. Kantarjian stated that the prices manufacturers charge for cancer drugs has risen from below $10,000 per year in the late 1990s, to over $200,000 annually today.

This is not the entire cost. Dusetzina said hospitals often hugely inflate the price of drugs in the bills they issue “so that if someone doesn’t pay, [the hospital] can write it off.”

Merith Basey, executive director of Patients for Affordable Drugs, an advocacy group, said no ordinary person can handle the price of these drugs.

“It’s simple: Drugs don’t work if people can’t afford them … no one should be poor because they are sick or be sick because they are poor,” She spoke.

Davis isn’t the first to stare down a huge medical bill.

Davis and Elizabeth Moreno, his daughter, were the subjects of the debut article 2018 in the KHN–NPR “Bill of the Month” series are better than her $17,850 bill for a urine test.

Davis ended up paying $5,000 to a Texas laboratory to settle the bill. Private insurers claimed that it should have been less than 100 dollars. Davis spoke at a May 2019 symposium. White House event To support legislation that will crackdown on “surprise” Medical bills.

He knew his position on the urine testing bill. He now faces escalating cancer care costs without knowing how this will impact his family’s finances.

“How do you make an informed choice if you have no information?” Davis asked.

KHN The Kaiser Health News is a national newsroom that focuses on health issues. KHN, along with Policy Analysis and Polling are the three main operating programs. KFF (Kaiser Family Foundation). KFF, an endowed nonprofit organization, provides information about health issues for the nation.