Billions of dollars in Medicare payments will be at stake this week when the Center for Medicare and Medicaid decides whether or not to add three additional drug compendia to the one that physicians already use to justify reimbursement for off-label use of cancer chemotherapy drugs. The projected decisions dates were June 2-4, according to an official I interviewed earlier this month.

Last Thursday, I sent this letter to CMS asking them to hold off on making the decision until one of the compendia -- published by the elite National Comprehensive Cancer Network -- lets the public and patients know if the physicians who wrote it have ties to manufacturers whose drugs they are evaluating.

So far, no reporter has picked up on this story (I first wrote about it here.) I find this curious. I've read a number of stories in recent months about the high cost of newer anti-cancer drugs, and how people are going broke or deep into hock trying to afford the co-pays. Newer anti-cancer biologics like Genentech's Avastin often carry price tags nearing $10,000 a month. If the use is listed in an approved compendia, Medicare and Medicaid will pay some or even most of that cost. Private insurance companies often follow Medicare's lead on payment issues.

But patients in private plans (those under 65) often have to pay a quarter or more of that price as a co-pay. They rarely have the research skills to determine if taking those drugs is the best thing to do given their dire circumstances. They usually rely on their oncologists. And their oncologists rely on these compendia to come up with off-label regimens for their desperate patients, who are often in the final stages of their ultimately fatal disease.

The evidence for including many of the off-label uses in these compendia is thin. Many, at best, add just a few months of life, often with harsh side effects. Yet they must be taken throughout the final months or even years of the diseases' progress.

It is always a close call whether or not to include these possible uses in compendia that lists both on and off-label uses. If it wasn't, the companies would have gone to the Food and Drug Administration and sought approval for that indication. Is it too much to ask on behalf of patients, doctors, and taxpayers that physicians without ties to the manufacturers make the compendia inclusion decisions? If CMS isn't willing to go that far, is it too much to ask that an agency facing long-term fiscal instability at least require that the physicians who write the compendia tell us which drug companies they work for?

Billions of dollars a year are at stake in the decisions that are slated to be made next week. Hopefully, someone on Capitol Hill is paying attention.