MEDICARE UPDATES ITS LIST OF RECOGNIZED SOURCES TO HELP MAKE COVERAGE DECISIONS FOR ANTI-CANCER CHEMOTHERAPY DRUGS
The Centers for Medicare & Medicaid Services (CMS) today announced changes to ensure that the most up-to-date information is used to determine which drugs may be covered under Medicare Part B to treat patients undergoing chemotherapy.
CMS will recognize the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium™ as an additional source of information and cease use of the no longer updated or maintained American Medical Association Drug Evaluations (AMA-DE) compendium. Medicare law directs CMS to consider certain listed compendia when deciding whether or not the use of a drug is medically accepted for the treatment of cancer. The law also allows the agency to revise the list. Both of these revisions will be reflected in CMS’ Medicare Benefit Policy Manual.
"We use these compendia to ensure that that Medicare beneficiaries can be assured that the Medicare contractors and their physicians have the most up-to-date drug information and the best available treatment options. This is important because today's ever-expanding industry of drug treatments is dynamic, requiring the constant monitoring and assessment of new interventions,” said CMS Acting Administrator Kerry Weems.
A compendium is a comprehensive listing of FDA-approved drugs and biologics. In some cases, compendia specialize in a particular subset of drugs, such as those used for anti-cancer treatment. Compendia include a summary of how each drug works in the body, as well as information for health care practitioners about proper dosing and whether the drug is recommended or endorsed for use in treating a specific disease.
The Medicare local contractors, who process and pay Medicare claims and approve coverage for drugs under Medicare Part B, use compendia as one of several tools to determine whether an anti-cancer drug should be covered under Medicare Part B.
Before approving coverage for a drug, contractors look at whether the drug is FDA approved for use in treating the beneficiary’s type of cancer in the beneficiary’s specific clinical circumstances. In some instances, however, the medical community may have scientific evidence that supports using a drug to treat a disease even if the drug’s FDA approved label does not include those clinical conditions. In these instances, certain drug compendia may recommend uses beyond those included in the FDA approved labels.
Over the years, some compendia have merged with other publications or have discontinued updating their entries. In particular, one of the compendia listed in the law, the AMA-DE Compendium, has not been published since 1995.
To ensure that contractors continue to have access to up-to-date drug compendia to make coverage decisions for anti-cancer drugs, CMS created a process to change its compendia reference list. This process included the recommendations from CMS’ Medicare Evidence Development & Coverage Advisory Committee, which advised CMS on the factors the Agency should consider when updating the list of compendia. The process also includes a 30-day public comment period.
Today’s decision to recognize the NCCN Drugs & Biologics Compendium™ and discontinue use of the AMA-DE Compendium is CMS’ first step in updating its compendia reference listing.
For more information about these compendium decisions, please visit the CMS website at http://www.cms.hhs.gov/CoverageGenInfo/02_compendia.asp.