CMS Required To Reverse Medicare Coverage Decision For Anemia Medications

Armen Hareyan's picture
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Reps. Anna Eshoo (D-Calif.) and Mike Rogers (R-Mich.) on Thursday introduced a bill (HJ Res 54) that would reverse a CMS decision to limit Medicare coverage for use of anemia medications -- Aranesp, manufactured by Amgen, and Procrit, manufactured by Johnson & Johnson -- in cancer patients, CQ HealthBeat reports (CQ HealthBeat, 9/28).

According to a 61-page "national coverage determination" announced in July, Medicare will cover the medications, synthetic forms of the protein erythropoietin, to treat anemia caused by chemotherapy but not anemia caused by cancer. Under the decision, Medicare will cover the medications to treat anemia in cancer patients whose hemoglobin levels decrease to less than 10 grams per deciliter of blood. The decision will allow local Medicare contractors to determine whether to cover the medications to treat patients with myelodysplastic syndrome, a condition that can lead to leukemia (Kaiser Daily Health Policy Report, 7/31).

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The legislation, a Congressional Review Act joint resolution, would require CMS to reverse the decision (Young, The Hill, 10/2). The House has not scheduled a vote on the bill, which requires approval from Congress and President Bush (CQ HealthBeat, 9/28).

The legislation likely will fail but might prompt CMS officials to revise the decision, according to Lehman Brothers analyst Tony Clapsis. A White House spokesperson declined to comment on the bill (Perrone, AP/Ventura County Star, 9/29).

In a letter sent earlier this year to CMS that included signatures from 235 House members, Eshoo wrote that the decision would require more cancer patients to undergo blood transfusions and could lead to shortages in the blood supply as a result. Fifty-two senators also signed a letter sent earlier this year to CMS in opposition of the decision (CQ HealthBeat, 9/28). In a letter sent last month to several physician groups, CMS officials wrote that they would not revise the decision without additional evidence (AP/Ventura County Star, 9/29).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives. The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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