In a Decision Memorandum dated May 31, 2000, the Health Care Financing Administration (HCFA) stated its intent to change its national non-coverage policy on autologous stem cell transplantation (AuSCT) for patients with multiple myeloma. In the new national coverage policy, HCFA limited coverage of this procedure to patients less than age 78. This decision was made because none of the studies reviewed by the agency enrolled any patients over age 77, primarily because investigators felt that age-related comorbidities precluded the safe provision of the procedure. Since no specific comorbidities could be identified that predicted who would be harmed by the procedure, we chose age 78 as the best available proxy to ensure patient safety while maximizing access to this treatment. Upon further internal consideration, HCFA has decided to further explore whether specific comorbidities can be found that will identify patients who face unacceptable risk from this procedure. The age restriction that would have become effective on October 1, 2000, will not be implemented.
