[FWD: [VAPCACOALITION] Bureau of National Affairs Report on MedPAC/Least Costly Alternative]

[Guest guest]

This may be of interest to patients on Medicare concerning potential

possible changes in their medicines. You may want to write to your

legislator.

KAthy

> Volume 17 Number 43 Page 1329

> Friday, November 3, 2006

>

> ISSN 1521-4699

>

> Legislative News

>

>

>

> Part B Drugs

> Cancer Groups Ask MedPAC to Suggest

> CMS End Least Costly Alternative Policy

>

>

> The application of least costly alternative (LCA) policies by Medicare

> contractors for determining payment for drug therapies could threaten care

> of beneficiaries and should be dropped, a coalition of cancer groups told a

> congressional advisory board.

>

> " LCA policies for prostate cancer drugs are inappropriate because they

> substitute Medicare's determination that certain drugs are interchangeable

> for the physician's professional judgment that one drug may be more

> efficacious or have fewer side effects for a particular patient, " the

> groups wrote on Oct. 25 to staff of the Medicare Payment Advisory

> Commission.

>

> MedPAC is considering recommendations for its March report to Congress on

> payment policies for Medicare Part B in-office drugs. The letter was signed

> by groups representing patients: the Men's Health Network, National

> Prostate Cancer Coalition, Prostate Health Education Network Inc., and Us

> TOO Prostate Cancer Education & Support.

>

> LCA Policies

>

> LCA policies allow local contractors to avoid paying the additional cost of

> a more expensive item if a clinically comparable item costs less.

> Contractors determine whether a particular drug meets the program's general

> requirements for coverage and, if so, whether payment may be made for the

> drug in the particular circumstance under which it was furnished. Among the

> determinations is whether an alternative to the drug exists, and meets the

> requirements of the " least costly " rule.

>

> " Drugs that are not deemed to be therapeutic equivalents by the [Food and

> Drug Administration] may be administered in different ways and produce

> different effects in a patient, including complications, side effects, and

> levels of efficacy, " they said. " LCA policies for prostate cancer drugs are

> inappropriate because they substitute Medicare's determination that certain

> drugs are interchangeable for the physician's professional judgment that

> one drug may be more efficacious or have fewer side effects for a

> particular patient. "

>

> In addition, LCA policies can have financial impact on beneficiaries. " The

> patient who chooses to receive the more costly therapy may be required to

> sign an advance beneficiary notice and to reimburse the provider for the

> difference in cost between the therapies, " the groups said. This could

> discourage patients from receiving the most appropriate treatment based on

> their income.

>

> " Continued use of LCA policies may lead physicians to prescribe medicines

> based on cost, rather than on what is best for the individual patient, " the

> groups said. Further, because Part B drug prices are determined quarterly,

> " physicians may need to change a patient's treatment mid-course, resulting

> in a significant physical and emotional toll on the patient. " The

> coalition groups said in the letter that " we are hopeful that MedPAC will

> recommend suspending current LCA policies. "

>