July 31, 2007
Very Good News — with our thanks!
The Center for Medicare and Medicaid Services (CMS) issued its final National Coverage Decision (NCD) regarding the use of ESAs in treating non-renal (or non-kidney) disease late Monday, July 30. In the proposed decision memo issued in May, CMS planned to eliminate all coverage of ESAs for MDS patients. The AA&MDSIF adamantly opposed this proposal, on the grounds that the science did not support that decision. Concerned about access to ESAs for Medicare beneficiaries as well as for patients whose private health insurers often follow CMS policy, we actively worked to reverse the CMS decision.
We are pleased to tell you that in yesterday’s decision, CMS chose not to remove coverage of ESAs for MDS and reversed its original proposal that Medicare beneficiaries with MDS could not receive ESAs.
There is one caveat to this good news in that CMS did not say that ESAs must be covered but said only that it was not removing coverage. The final policy also allows “(l)ocal Medicare contractors…(to) continue to make reasonable and necessary determinations on all uses of ESAs that are not determined by NCD,” including MDS. We will monitor local contractors’ policies closely, but, because the science supports using ESAs for MDS, we would expect all local contractors to cover ESAs for MDS. (If coverage is restricted in any region, the Foundation will mobilize its resources again.) All in all, this NCD is very good news.
We will have a more complete analysis of this NCD posted on our website http://www.aamds.org later this week.
We want to thank all of you who wrote, faxed, emailed, and called your congressional representatives and submitted comments to CMS. Several news organizations including The New York Times made note of the more than 2600 comments CMS received from physicians, medical societies, patient groups, and patients. They also referenced some of our specific comments.
We also want to thank the members of the House of Representatives and Senate who supported our efforts in convincing CMS that MDS patients need continued access to ESAs and the staff of CMS who listened to the medical evidence we presented.
YOU — our patients, friends and supporters — made the difference in keeping this vitally important treatment available to MDS patients. WELL DONE !!
Note that while ESAs are used for bone marrow failure disease patients, the CMS proposed decision memo and final decision affected only ESAs for MDS.
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