News in brief - April 11, 2011

Medicare to cover $93,000 prostate cancer drug

The agency overseeing Medicare said the program will cover the $93,000 advanced prostate cancer treatment drug Provenge, according to a March 30 proposed national coverage decision memo.

Evidence suggests that autologous cellular immunotherapy treatment will improve the health outcomes of Medicare patients with asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer, the memo states.

Provenge is not like most drugs. Doses are produced only when a physician decides to treat a patient with the drug. It is made individually for each patient using his own white blood cells.

Medicare patients currently have coverage for the drug, according to a statement from Dendreon Corp., the Seattle-based biotech company that produces Provenge. All 15 of Medicare's regional contractors have coverage guidelines or have provided written or verbal guidance on coverage. If finalized, the national coverage determination would apply the same coverage standard to all beneficiaries.

In 2009, an estimated 192,280 new cases of prostate cancer were diagnosed and 27,360 deaths were reported, according to the Centers for Medicare & Medicaid Services.

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Arizona governor calls for more limited Medicaid cuts

Arizona Gov. Jan Brewer on March 31 asked the Dept. of Health and Human Services for permission to freeze Medicaid enrollment for childless adults and parents and charge a $50 annual fee to Medicaid enrollees who smoke, among other co-payments.

Brewer's latest plan to reduce the state's Medicaid spending is less drastic than earlier proposals that, for example, would have ended coverage for the 220,000 childless adults in the state's Medicaid program. The enrollment freeze instead would result in 100,000 childless adults losing coverage beginning July 1. The new proposal would freeze Medicaid enrollment for parents earning between 75% and 100% of the federal poverty limit, meaning about 30,000 parents would lose coverage beginning Oct. 1, said Monica Coury, assistant director of intergovernmental relations for the Arizona Health Care Cost Containment System, the state's Medicaid agency.

Brewer's request comes about a month after HHS Secretary Kathleen Sebelius indicated that the department would be flexible about Arizona and other cash-strapped states allowing some expanded state Medicaid coverage to expire.

The Arizona request is available online: (www.azgovernor.gov/dms/upload/pr_033111_lettersecretarysebelius.pdf).

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Raising Medicare age would save $7.6 billion in 2014, study finds

Health care costs would shift away from the federal government if the Medicare eligibility age were raised from 65 to 67, a Kaiser Family Foundation study concludes.

The foundation released the March analysis as lawmakers and health care policy officials debate the projected effects of raising the retirement age in an effort to cut costs. Federal spending would be reduced by $7.6 billion in 2014 if such a policy were adopted, according to the study.

The analysis assumes the health system reform law would continue to be implemented and that the roughly 5 million people affected by the eligibility change would look for coverage elsewhere that year. An estimated 42% would receive employer-sponsored health coverage, 38% would enroll in an individual plan from a health insurance exchange, and 20% would be covered by a Medicaid plan.

This would cause average premiums for other Americans to rise, the study said. People using the exchanges would see a 3% increase to account for the addition of more older Americans in risk pools. At the same time, Medicare Part B premiums would rise 3% because fewer healthier, lower-cost patients would be paying into the program.

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Minnesota high court to consider tobacco lawsuit

The Minnesota Supreme Court will review a lower court's decision reinstating a 10-year-old lawsuit against tobacco company giant Philip Morris.

The lawsuit originally was filed in 2001 by a group of consumers who claimed Philip Morris engaged in deceptive marketing when it advertised its low-tar cigarettes as safer than regular cigarettes. A trial judge dismissed the case in 2009, ruling the plaintiffs did not have standing to sue because they could not prove their cause of action benefited the public.

In December 2010, the Minnesota Court of Appeals reversed that decision, saying the suit was valid under the state's consumer-protection laws and could move forward. Philip Morris appealed to the state's Supreme Court.

In March, the high court agreed to examine the case. At this article's deadline, the court had not set a date for oral arguments.

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