Procrit and Aranesp: CMS Denies Reimbursement with New Policy

The Centers for Medicare & Medicaid Services (CMS) recently implemented a change in the coverage of two necessary drugs used in conjunction with the treatment of cancer. Procrit and Aranesp are given to cancer patients who suffer from anemia due to low red blood cell counts as a result of chemotherapy. These drugs have been used successfully in accordance with current Federal Drug Administration (FDA) regulations in relieving the fatigue associated with the anemia of chemotherapy and also keep patients from potentially undergoing blood transfusions which may have serious side effects and are costly. CMS is now restricting coverage for these drugs in the case of many Medicare and Medicaid patients.

By doing this, we believe CMS is now applying their own policies to treat patients.

• These policies are not in line with FDA recommendations.
• They are not in line with current treatment guidelines and lack scientific research and findings.
• They are not in line with what's best for patient care and quality of life.

We think it's critical that our voices and the voices of our patients be heard before more policies are created adversely affecting patient care. Please help your patients by starting your own grass roots campaign. Encourage them to write to their senators and local congressional representatives. Attached is a sample flyer you can distribute to patients to help them understand the important points to cover in their letter. This sample has been provided by William M. Dugan, Jr., MD, a medical oncologist/ hematologist from Indiana. Also attached is an opinion/editorial Dr. Dugan submitted to local newspapers in Indiana about this issue.

View documentation on the coverage checklist for Procrit and Aranesp.

For more information contact us:
Neltner Billing and Consulting
6463 Taylor Mill Road
Independence, KY 41051
888-635-8637
info@neltnerbilling.com