Sen. Baucus Introduces Resolution To Reverse CMS Decision On Medicare Coverage For Anemia Medications

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Blood / Hematology
Article Date: 24 Oct 2007 - 8:00 PDT

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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).

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, 10/19).

The legislation, a Congressional Review Act joint resolution that requires approval from Congress and President Bush, would require CMS to reverse the decision. According to Baucus, the decision "will prevent vulnerable cancer patients from getting the care they need." He added, "Esteemed clinicians state, and no one has refuted, that the cap set by CMS will require thousands of patients to seek blood transfusions that could 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 Hematology on Monday criticized the CMS decision and released new guidelines for use of anemia medications based on a three-year review of clinical trials (Bloomberg/Los Angeles Times, 10/23).

Stabenow Criticizes Dialysis Treatment Provision
Sen. Debbie Stabenow (D-Mich.) on Monday raised concerns about a potential provision in a Medicare bill drafted by the Senate Finance Committee that would reduce reimbursements for dialysis treatments for beneficiaries with End Stage Renal Disease, CQ HealthBeat reports. Under the provision, Medicare would not cover dialysis treatments for beneficiaries with private health insurance for 42 months, compared with 30 months currently. The provision would save an estimated $1.2 billion over 10 years, according to a Congressional Budget Office analysis.

"Every major employer and manufacturer that provides good health insurance is concerned about this," Stabenow said. The committee likely will complete a draft of the bill before a congressional recess begins on Nov. 16 (Armstrong, CQ HealthBeat, 10/22).

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