Revisions Possible for Medicare Payments for Anemia Drugs
Lawmakers might consider revisions to the Medicare reimbursement policy for anemia medications used in the treatment of kidney dialysis patients, after experts at a House Ways and Means Committee hearing on Wednesday testified that the policy encourages "overuse that is wasteful, costly and raises the risk of heart complications," Reuters/New York Times reports.
Under the policy, Medicare reimburses kidney dialysis centers for the anemia medication Epogen, manufactured by Amgen, and similar treatments at a 6% premium over the average sale price and reimburses them separately for dialysis services.
At the hearing, Dennis Cotter, head of the Medical Technology and Practice Patterns Institute, and other experts testified that the policy has allowed Medicare reimbursements for anemia medications to serve as a revenue source for kidney dialysis centers. They said that Medicare should bundle reimbursements for anemia medications and dialysis services, a policy that would encourage physicians to use the proper amount of the treatments (Reuters/New York Times, 12/7).
According to Cotter, the current policy encourages physicians to overuse anemia medications to increase Medicare reimbursements, a practice that places kidney dialysis patients at increased risk for heart attacks (Reichard/Adams, CQ HealthBeat, 12/6).
Acting CMS Administrator Leslie Norwalk defended the policy. She said that "our policy position is to follow the FDA label and its target hematocrit levels" but added that those levels can vary.
Josh Ofman -- Amgen vice president of global coverage and reimbursement, who did not testify at the hearing -- said, "Any changes to the policy should be rigorously considered based on input from physicians and other experts."
Committee Chair Bill Thomas (R-Calif.) said that, because kidney dialysis centers do not receive regular annual Medicare reimbursement updates to account for their increased costs, they have a financial incentive to overuse anemia medications (CQ HealthBeat, 12/6).
According to Rep. Charles Rangel (D-N.Y.), who next year will become committee chair, Medicare has encouraged "through policy the overuse of a drug that places patient lives at risk" and is expensive.
Rep. Pete Stark (D-Calif.) said that two-thirds of the advisory committee that helped Medicare develop the policy have ties to kidney dialysis and pharmaceutical companies (Rowland, Boston Globe, 12/7).
CMS plans to review the Medicare reimbursement policy for anemia medications and issue a report next summer (CQ HealthBeat, 12/6).