Highmark Inc. is reconsidering a new policy that requires certain Medicare subscribers to make co-payments each time they are injected with a cancer-fighting drug by their doctors.

Some local oncologists oppose the outpatient co-pays -- up to $25 each for chemotherapy agents, immunosuppressants, anti-nausea drugs and more -- saying they can add up quickly for patients getting several shots per day, several days a week.

Highmark officials met last week to discuss the matter. They've also been in contact with the Centers for Medicare & Medicaid Services, the federal agency that must annually sign off on all policy changes made to a private insurer's Medicare offerings.

The key word is "annually."

"Generally, they don't allow health plans to make changes in the middle of year," said Highmark spokesman Michael Weinstein. "We can't do it on our own ... our folks are dealing with [CMS officials] as we speak."

If a change is permitted, reducing or eliminating the co-payments for cancer drugs, the patients who already have been charged a co-payments could get a refund, Mr. Weinstein said.

Dr. James Bress, a South Side oncologist, said last week that Highmark would be forced to retreat on the issue. "Highmark has seen the light," he said.

But Mr. Weinstein said nothing is resolved, and that "anything could happen."

Highmark, Pittsburgh's dominant health insurer and a Medicare contractor, this year began collecting co-payments from subscribers to two Medicare Advantage offerings, FreedomBlue and SecurityBlue, who receive injected drugs.

The drugs can cost hundreds or thousands of dollars per dose, and Highmark says the new co-pays offset a theoretical $5-a-month premium increase.

But that's the point of insurance -- to spread risk and expense across a broad payment base, says California Health Advocates, which studies Medicare policy: "This trend appears to reflect a deliberate business strategy of placing the burden of cost increases on the highest users instead of spreading them out across all plan members."

"Some of the plans began doing this a couple of years ago. It came as a surprise," said Bonnie Burns, a policy specialist with the California group.

"This is a blatant discriminatory practice against people who have a critical illness," she said.

Highmark, and many other privately administered Medicare HMOs, cover the chemo services under Part B. In recent years, cancer patients have seen increasing co-payments for these drugs and services.

Why? According to a Harvard Law study, "despite the fact that Medicare Part B provides coverage for only about 450 unique drugs, the spending on these drugs has been substantial, totaling a staggering $8.4 billion in 2002," more than 3 percent of Medicare's total spending at the time. "The massive expense of the Medicare Part B program has made it the focus of widespread scrutiny."

And so both insurers and the federal government are grappling with how best to deal with the rising expenses; the number of Americans with cancer is expected to double between now and 2050.

The higher expenses are doubly difficult for the cancer patients who receive injected or infused cancer drugs through Medicare Part B offerings because Part B, unlike Part D (which covers most take-home prescription drugs), has no mandated out-of-pocket threshold that caps expenses for patients.

It's the second time it two years that cancer patients who receive Medicare benefits have been hit in the pocketbook. Two years ago, when Medicare Part D first took effect, many of the hugely expensive oral cancer drugs that patients had been receiving through other means came under the umbrella of Part D. And once that happened, Medicare enrollees who subscribed to the benefit were obligated to pay $3,600 in out-of-pocket costs each year before the full drug coverage kicked in.

And some smaller practitioners have stopped administering cancer drugs altogether to Medicare patients, leaving the job to hospitals, saying they can no longer afford to supply the drugs because of Medicare's low reimbursement rate.