Medicare imposes limits on anemia drugs

Physician organizations will keep trying to get CMS to reopen its decision on treating cancer patients.

By David Glendinning, AMNews staff. Aug. 27, 2007.

Washington -- Medicare officials last month decided not to go as far in limiting coverage of a key anemia drug for cancer patients as they initially said they would. But physicians still are worried that the new policy will hamstring them and keep some patients from getting their needed treatments.

The Centers for Medicare & Medicaid Services released July 30 a final national coverage determination on Medicare coverage of erythropoiesis-stimulating agents, known generically as darbepoetin and epoetin, in patients with certain types of cancer. The drugs, which are designed to raise hematocrit levels, are manufactured respectively by Amgen as Aranesp for cancer patients and by Johnson & Johnson under the name Procrit. Amgen also produces Epogen for patients with kidney disease.

In May the agency released a proposed coverage determination that would have limited more strictly the conditions under which Medicare would pay for the drugs for cancer patients. For beneficiaries with certain types of the disease, the coverage would have disappeared altogether.

The proposal came after the Food and Drug Administration issued a series of warnings and recommendations for epoetin agents because of the potential for strokes and hearts attacks if the drugs were used too readily.

But the uproar that ensued from physicians and from patient advocates, who sent more than 2,600 comments to CMS, caused the agency to back off its original stance and soften the proposed limits. Instead of ruling out coverage altogether for patients with certain cancer types or who are undergoing certain other treatments, it is keeping the coverage open for beneficiaries whose anemia is caused by their chemotherapy -- regardless of tumor type or secondary treatment. For myelodysplastic syndrome, a condition for which coverage would have been prohibited under the original proposal, CMS now is leaving the coverage decision up to individual local Medicare carriers.