Medicare Payment Changes for Anemia Drugs Touted
The House Ways and Means Health Subcommittee on Tuesday held a hearing to consider proposals to revise the Medicare reimbursement system for anemia medications administered to kidney dialysis patients, Dow Jones reports.
Several studies in recent years have found that the system provides an incentive for dialysis centers to overprescribe anemia medications, according to CMS. Dialysis medications account for about $2 billion in annual Medicare expenditures (Loftus, Dow Jones, 6/26). In addition, several recent studies have found that high doses of anemia medications can increase risk of heart attack, stroke and death.
Subcommittee Chair Pete Stark (D-Calif.) said, "The current Medicare reimbursement system creates incentives for higher dosing of anemia drugs, which lead not only to health risks but also come at a higher cost to taxpayers" (Lopes, Washington Times, 6/27).
However, Joshua Ofman -- vice president of global coverage and reimbursement at Amgen, which manufactures anemia drugs -- said, "There does not appear to be a compelling policy or clinical rationale to immediately make fundamental, untested changes to the dialysis payment system" (Dow Jones, 6/26).
At the hearing, some experts said that CMS should bundle Medicare reimbursements for anemia medications with payments for dialysis services to eliminate the incentive to overprescribe the treatments (Reuters/Los Angeles Times, 6/27).
Acting CMS Administrator Leslie Norwalk said that the agency is "generally supportive" of the recommendation but has concerns that the bundled Medicare reimbursements might prompt some dialysis centers to offer fewer medically necessary services to beneficiaries (Dow Jones, 6/26).
CMS in October 2005 planned to present to lawmakers a report on a proposal to bundle Medicare reimbursements for anemia medications with payments for dialysis services, "but the agency has fallen behind," CongressDaily reports.
Norwalk said that CMS will present the report before she leaves the agency this summer. Norwalk said, "Until a bundled PPS (prospective payment system) changes incentives effectively reducing over utilization" of anemia medications, "we are taking action to strengthen our current ESA monitoring policy."
Norwalk said CMS in January 2008 will begin to reduce Medicare reimbursements by 50% for beneficiaries who receive the maximum dose of anemia medications for three consecutive months, a change that will affect about 5% of beneficiaries who receive such treatments (Edney, CongressDaily, 6/26).
Subcommittee ranking member Dave Camp (R-Mich.) said that "any type of bundled payment must provide a proper adjustment to account for sicker patients."
In addition, Del. Donna Christensen (D-Virgin Islands) said that proposals to revise the Medicare reimbursement system for anemia medications would disproportionately affect black beneficiaries because 38% of dialysis patients are black and because black patients "require high doses" of such treatments.
Stark said that proposals to revise the Medicare reimbursement system for anemia medications should account for the medical conditions of individual beneficiaries (Reichard, CQ HealthBeat, 6/26). Stark also expressed interest in a technique that would require dialysis centers to first attempt to administer anemia medications subcutaneously, a practice that requires a one-third smaller dose than administration intravenously.
Stark said that he might include proposals to revise the Medicare reimbursement system for anemia medications in a broader bill (CongressDaily, 6/26).
House Democrats have begun to draft such legislation for a possible mark up next month by the House Ways and Means Committee and the House Energy and Commerce Committee. "Whether we can do that or not, I don't know," Stark said.
After the hearing, Stark said that such proposals could save "a couple billion" dollars over five years that Congress could use to reverse a 10% reduction in Medicare physician reimbursements scheduled to take effect next year (CQ HealthBeat, 6/26).