Hearing To Address Medicare Coverage for Anemia Drugs
The House Ways and Means Committee on Thursday plans to hold a hearing to discuss the cost and safety of anemia medication used to treat patients with end-stage renal disease and Medicare reimbursements for such treatments, The Hill reports. According to an analysis published in October by the journal Health Affairs, Medicare in 2005 spent $1.75 billion on anemia treatments, which represent the largest medication expense for the program.
The anemia medications Epogen and Aranesp, manufactured by Amgen, and Procrit, manufactured by Johnson & Johnson -- all of which have the same active ingredient epoetin -- have no generic competition. The lack of generic competition for anemia medications limits "the power of market forces to moderate price," according to a recent Government Accountability Office report.
In addition, according to the Health Affairs analysis, "liberalization" of the Medicare coverage "benefit for epoetin therapy over the years has created a financial incentive for its increased use."
In a recent letter to acting CMS Administrator Leslie Norwalk, committee Chair Bill Thomas (R-Calif.) and ranking member Rep. Pete Stark (D-Calif.) criticized a policy under which Medicare reimburses for the administration of doses of anemia medications that exceed the level recommended by FDA. The lawmakers wrote, "We are deeply concerned that the current CMS policy is not aggressive enough to stem the systemic abuse of Epogen, resulting in costs to taxpayers and potential health dangers to patients."
Thomas and other lawmakers have proposed reforms to the Medicare reimbursement system that would combine services, medications and other expenses related to kidney dialysis treatment. Thomas and Stark also cited a recent study published in the New England Journal of Medicine as evidence against the CMS policy (Young, Hill, 12/6).
The study, conducted by researchers at Harvard Medical School and sponsored by J&J, found that kidney disease patients treated with high doses of the anemia medications epoetin and darbepoetin had a 34% higher risk for heart attack, congestive heart failure, stroke and death than those treated with lower doses of the medications (American Health Line, 11/16).
According to the Los Angeles Times, in the event that "lawmakers signal that they want to curtail the amount of anemia drugs doctors prescribe, ... it would clearly pose a significant threat to Amgen's bottom line" because "the company's anemia lineup makes up almost half of its sales and 60% of its profit" (Costello, Los Angeles Times, 12/6).
In a statement, Amgen officials raised concerns that implementation of the proposed reforms to the Medicare reimbursement system would combine expenses related to kidney dialysis treatment "without appropriate case-mix adjusters." Amgen officials wrote, "A bundled system prior to the completion of a CMS demonstration project, if implemented poorly, could result in harm to patients and cost Medicare more money" (CQ HealthBeat, 12/5).