Oncologists consulted by ABC contribute dozens and dozens of anonymized reports to sustain their accusation that ATRES Health-Bienzobas presses them so that expensive cancer treatments are not prescribed with the objective of lower the invoice To the insurers. These … There are ten cases type provided by the complainants to justify the pressures that, according to their testimony, receive from the Oncologists of Atrys. The intermediary company denies it and ensures that its main interest is always to indicate the best treatment. The doctor always has the last word in the prescription, they say.
Colon cancer, 83 years
Cheaper and less effective treatment
«Colon carcinoma with liver metastases, native BRAF and her2 not amplified. No microsatellite instability. Perfect general condition. Patient who was treated with fluorouracil, irinotecan and panitumumab with great response and operated to remove liver metastases being tumor free. At nine months, hepatic relapse. It is proposed to restart treatment. ATRIS POBS proposes not to put panitumumab. The oncologist is ratified in the complete pattern by demonstrating its effectiveness, and being approved by the Spanish Medicine Agency. The insurer approves the treatment ».
This tries to reduce the cost of cancer treatments
ABC
“Athroly purely,” says oncologists in conversation with this newspaper, “it is allowed to recommend a lower quality treatment, with the worst response and with less survival in order to save in the panitumumab antibody. The treatment remained and the result was control of the disease ».
Breast cancer, 47 years
It is not funded by the health system
«Sick of breast cancer with ganglia involvement in axila, luminal her 2 amplified diagnosed at 45. It was treated with chemotherapy and double her2 block (phesgo) and then the breast was removed. The treatment standard is to continue with her 2 block after surgery ».
ATRIS BUENZOBAS stated that the treatment was not financed by the National Health System and recommend blocking only with an antibody – Trastuzumab- to save the second drug (Pertuzumab, included in Phesgo). The oncologist ratified and the insurer approved it. In this case they affirm that Phesgo (double monoclonal antibody for the treatment of breast cancer her 2 positive in early breast cancer) is not financed by the National Health System. “It is false,” says the doctors, “since it was approved by the European Commission in 2020 and by the Spanish State in May 23. When Patre Piezobas claimed that the financing was not approved for several months. In addition, they claim that it is not indicated in the adjuvant (post-operative) treatment in this case, ”they add.
Bladder tumor, 89 years
Is not in technical file
«Good general condition and perfect cognitive condition. Uurotelial Carcinoma of Bladder Stadium IV. It had been treated with carboplatin and gemcitabine with bad tolerance. Immunotherapy with pembrolizumab is indicated in the second line, expensive immunotherapy that is the standard in these cases, in technical file and endorsed by all international consensus guides (European tuxedo guide and NCCN (North American). ATRIS Bienzobas states that it is not in the technical file of the Spanish Medicine Agency. The oncologist presents the technical file and is ratified. The insurer approves the treatment.
“In this case there is no better argument than to copy and paste the indication of the technical file,” says oncologists: “They lie to avoid a expensive drug approved and recommended by international scientific organizations of medical oncology.”
Breast cancer, 61 years
A cheaper alternative
«A patient with a metastatic breast carcinoma her 2 positive with the progression of the disease to previous treatments with chemotherapy and trastuzumab. TRUBZUMAB Deruxtecan treatment is proposed, in technical file, which It is the standard In this situation and recommended by all European and American consensus guides. Piezobas ATROS responds recommending TDM-1 (obviously cheaper but more ineffective). The oncologist is ratified in its treatment and the insurer authorizes it «.
“It is a clear case of lower quality (and cheaper) treatment recommendation despite the scientific evidence that Trasuzumab Deruxtecan, proposed by the oncologist provides more tumor responses and more survival than TDM-1 in a contrasted and published way and for what has been approved by all consensus guides and by European and Spanish regulatory agencies,” they explain to ABC.
Gastric tumor, 77 years
It is not authorized
«Operated by gastric cancer and in a complementary way with chemotherapy (fluorouracil, folinic and oxaliplatin). The progression of the disease occurs and treatment is indicated with Ramucuab, monoclonal antibody approved for this indication and Recommended in all international consensus guides. From ATRES Bienzobas they deny the treatment for not being in a technical file. The oncologist is ratified by providing it. The insurer finally approves the treatment.
Oncologists say that “this is a case in which they lie saying that the drug is not in a technical file to avoid the cost of its application. Again, analyze the technical file, demonstrates that the intermediary tries to eliminate expensive and legal treatment in a false way ».
Colon Cancer, 70 years
Technical obstacles
«Sick with disseminated colon cancer in the first line of treatment. Treatment with fluorouracil, folin, oxaliplatin and bevacizumab is requested. The Advisor of Piezobas states that Bevacizumab is not in a technical file. The oncologist is ratified and the insurer approves it ».
Metastasis in breast, 53 years
Denied medication
«Patient with metastatic breast cancer HER 2 amplified and sick since the age of 37. It had been treated with chemotherapy, Block Her 2 and within clinical trials having survived more than 15 years. Eribulin is indicated as a new treatment and maintenance of her 2 blockade with Trasuzumab. Pens well Deniega Eribulina in combination with Trasuzumab. The oncologist is ratified and the insurance company approves it.
Oncologists give their version: «This was a MUFACE patient without the possibility of being treated outside the private environment and the treatment proposal remained. This is a completely tortic and economist interpretation case of the technical file. In the cancers of Mama Her 2 amplified, it is recommended technique Thus they try to save the cost of eibulin and passing from Trasuzumab. And that is scientifically inadmissible. In the successive treatments he has maintained Trastuzumab at all times. The same happens in metastatic prostate cancer. Although successive chemotherapies are put on the tumor, the androgens blockade of the patient’s life must be maintained ».
Breast cancer, 72 years
No public financing
«72 -year -old patient with metastatic breast cancer Her2 low from 62 years and treated with different treatments and long survival. TRASTUZUMAB DERUXTECAN is indicated. The ATRIS company states that although the treatment is adjusted to the technical file It is not funded by the National Health System. The oncologist is ratified and the insurer approves the treatment «.
This is the analysis of the denouncing oncologists: «They affirm that the indication of Trastuzumab deruxtecan has not approved the financing by the SNS what is flatly false because on the date of the denial of ATRES well lobes I was already financed For the National Health System for Metastaous Breast Cancers Her 2 Low. In spite of everything, and as on all other occasions they define the application as ‘not justified’ and reiterate it to the company for twice on the same day what is surely a negative signal for the oncologist directed to the insurance company ».
Pancreatic cancer, 79 years
Out of technical file
«He is a 79 -year -old man, good general condition, with metastatic pancreas cancer since he was 78. It had been treated with two previous treatment lines, Folfirinox and Abraxane-Geemcitabin. Fluorouracil and Liposomal Iinotecan is requested. They denie the latter based on It is not in technical file. The oncologist is ratified and approved «.
“An attempt to avoid expensive treatment based on a false argument,” they denounce.
Metastatic Cancer, 45 years
Wrong treatment
«He is a 45 -year -old patient with Metasta Cancer HER 2 amplified, who has made multiple lines of care treatment and clinical trial to which Trastuzumab Emtansin is prescribed. ATRES Bienzobas denies it because it does not have injuries outside the nervous system and say that in the essay that served as authorization there were no patients with those metastases. The oncologist is ratified in the treatment, which is denied; It is ratified again and is definitively approved ».
«Despite the argument used, they do not say that in the approval of the European and Spanish agency of the medicine this limitation is not defined and that there are other studies that did integrate patients with brain metastases and benefited from treatment. The patient clearly complied with the technical file, ”the doctors conclude.
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