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Resolution To Reverse CMS Decision On Medicare Coverage For Anemia Medications

Armen Hareyan's picture

Anemia Medications

Senate Finance Committee Chair Max Baucus (D-Mont.) on Monday introduced a bill that would reverse a CMS decision to limit Medicare coverage for use of anemia medications -- Aranesp, marketed by Amgen, and Procrit, marketed by Johnson & Johnson -- in cancer patients, CQ HealthBeat reports (Reichard, CQ HealthBeat, 10/22).

Accordingto a 61-page "national coverage determination" announced in July,Medicare will cover the medications, synthetic forms of the proteinerythropoietin, to treat anemia caused by chemotherapy but not anemiacaused by cancer. Under the decision, Medicare will cover themedications to treat anemia in cancer patients whose hemoglobin levelsdecrease to less than 10 grams per deciliter of blood. The decisionwill allow local Medicare contractors to determine whether to cover themedications to treat patients with myelodysplastic syndrome, acondition that can lead to leukemia (Kaiser Daily Health Policy Report, 10/19).

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Thelegislation, a Congressional Review Act joint resolution that requiresapproval from Congress and President Bush, would require CMS to reversethe decision. According to Baucus, the decision "will preventvulnerable cancer patients from getting the care they need." He added,"Esteemed clinicians state, and no one has refuted, that the cap set byCMS will require thousands of patients to seek blood transfusions thatcould have been avoided." Reps. Anna Eshoo (D-Calif.) and Mike Rogers(R-Mich.) earlier this month introduced a similar resolution (HJ Res 54) in the House (CQ HealthBeat, 10/22).

In related news, the American Society of Clinical Oncology and the American Society of Hematologyon Monday criticized the CMS decision and released new guidelines foruse of anemia medications based on a three-year review of clinicaltrials (Bloomberg/Los Angeles Times, 10/23).

Stabenow Criticizes Dialysis Treatment Provision

Sen. Debbie Stabenow (D-Mich.) on Monday raised concerns about apotential provision in a Medicare bill drafted by the Senate FinanceCommittee that would reduce reimbursements for dialysis treatments forbeneficiaries with End Stage Renal Disease, CQ HealthBeatreports. Under the provision, Medicare would not cover dialysistreatments for beneficiaries with private health insurance for 42months, compared with 30 months currently. The provision would save anestimated $1.2 billion over 10 years, according to a Congressional Budget Office analysis.

"Everymajor employer and manufacturer that provides good health insurance isconcerned about this," Stabenow said. The committee likely willcomplete a draft of the bill before a congressional recess begins onNov. 16 (Armstrong, CQ HealthBeat, 10/22).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.