Oncologists Call For Medicare To Reconsider Anemia Drug Restrictions

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Anemia Drug Restrictions

Community Oncology Alliance (COA) formally requested that the Centers for Medicare & Medicaid Services (CMS) reconsider its decision to restrict the access of senior cancer patients to vital anemia-fighting drugs. Effective July 30, 2007, CMS implemented a National Coverage Determination (NCD) limiting oncologists' use of anemia-fighting drugs, referred to as Erythopoiesis Stimulating Agents (ESAs) in Medicare cancer patients undergoing chemotherapy treatment. Anemia is a common side effect of chemotherapy, and ESAs are used to minimize the need for red blood cell transfusions.

According to Dr. Patrick Cobb, a practicing oncologist from Billings, Montana, and Chairman of the COA Clinical Practices Committee, "What prompted this recent request to CMS to reconsider its decision to restrict ESA use was the release on November 8, 2007 of revised FDA-approved labeling for ESAs." Dr. Cobb added, "Unfortunately, what FDA considers safe and effective ESA use, CMS does not. As a result, our Medicare patients are not receiving the same standard of care as our younger patients."

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The ESA labeling revisions include additional warnings related to risks associated with the use of ESAs "when dosed to target a hemoglobin of >= 12 g/dL" and instructs physicians to "use the lowest dose needed to avoid red blood cell transfusions" in order to minimize risk. However, the FDA specifically notes in both the revised label and its accompanying press release dated November 8, 2007 that, "no clinical data is available" to establish the risk of using ESAs when hemoglobin levels are less than 12 g/dL. The CMS NCD, on the other hand, arbitrarily prohibits ESA use when hemoglobin levels are 10 g/dL or higher.

"We use ESAs to reduce the need to give our patients transfusions, so we don't expose them to undue risks," said Dr. Cobb. "ESAs are important drugs, as are all the therapies we use to treat our patients--patient safety is always our primary concern. However, what CMS has done is to actually limit our ability to use ESAs in a way that minimizes transfusions."

In its reconsideration letter to CMS, COA notes, "It is readily apparent the CMS NCD essentially overrules the FDA scientific expertise by deeming ESAs unsafe and ineffective when used in the range of >=10 g/dL and <12 g/dL. Equally distressing is the fact that CMS is using a reimbursement policy to substitute its own clinical judgment, rather than allowing physicians to exercise their own clinical judgment for each individual patient's circumstances, as recommended in the newly revised FDA-approved label." COA further notes, "there is evidence to suggest that initiating ESA treatment at a hemoglobin level >10 g/dL significantly reduces the risk of transfusion."

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