Medicare Eases Proposed Anemia Drug Restrictions
CMS on Monday announced a final decision that will limit Medicare coverage for use of anemia medications -- Aranesp, manufactured by Amgen, and Procrit, manufactured by Johnson & Johnson -- in cancer patients, but the decision is less restrictive than a proposal announced in May, the New York Times reports.
According to the 61-page "national coverage determination," Medicare will cover the medications, synthetic forms of the protein erythropoietin, to treat anemia caused by chemotherapy but not anemia caused by cancer. The decision eliminated provisions in the previous proposal under which Medicare would not have covered use of the anemia medications during chemotherapy for certain forms of cancer or in combination with the cancer treatments Avastin, manufactured by Genentech, or Erbitux, manufactured by ImClone Systems.
In addition, under the decision, Medicare will cover the anemia medications in cancer patients whose hemoglobin levels decrease to less than 10 grams per deciliter, compared with nine grams per deciliter under the previous proposal (Pollack, New York Times, 7/31).
The decision will allow local Medicare contractors to determine whether to cover the anemia medications for use in patients with myelodysplastic syndrome, a condition that can lead to leukemia (CQ HealthBeat, 7/30).
CMS officials decided to revise the previous proposal after the agency received more than 2,600 comments from physicians, patient groups and medical societies "who said the proposed restrictions went too far, were not based on scientific evidence and would possibly harm patients," according to the Times (New York Times, 7/31).
Acting CMS Administrator Herb Kuhn in a statement said, "Our goal was to maintain physician autonomy while ensuring the safety of our Medicare beneficiaries" (Chase, Wall Street Journal, 7/31).
Sanford C. Bernstein analyst Geoffrey Porges said that CMS decided to revise the previous proposal in the "face of massive outcry from patients, cancer physicians and others in the cancer community" (Bloomberg/Los Angeles Times, 7/31).
The decision could "provide some relief" for Amgen and J&J, as some analysts had said that the previous proposal could have reduced use of the anemia medications by as much as half, the Times reports (New York Times, 7/31).
An Amgen spokesperson said, "We are continuing to review the CMS decision and will work cooperatively with CMS to ensure that patients receive the treatment they need."
A spokesperson for the J&J Ortho Biotech division said that company officials have not completed a review of the decision (Wall Street Journal, 7/31).