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National Coverage Determination (NCD) for Aprepitant for Chemotherapy-Induced Emesis (110.18)

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Benefit Category
Oral Antiemetic Drugs

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

A. General

Chemotherapy-induced nausea and vomiting (CINV) can range from mild to severe, with the most severe cases resulting in dehydration, malnutrition, metabolic imbalances, and potential withdrawal from future chemotherapy treatments. The incidence and severity of CINV are influenced by the specific chemotherapeutic agent(s) used; dosage, schedule and route of administration; and drug combinations. Patient specific risk factors such as sex, age, history of motion sickness, and prior exposure to chemotherapeutic agents can also have an effect on CINV incidence and severity. Progress has been made in reducing CINV, although it can still be hard to control symptoms that occur more than a day after chemotherapy, during repeat cycles of chemotherapy, and when chemotherapy is given on more than one day or in very high doses. No single anti-emetic agent is completely effective in all patients. As noted above, many factors influence the incidence and severity of CINV, with the specific chemotherapeutic agent as the primary factor to consider when deciding which anti-emetic to administer. Aprepitant (Emend®) is the first Food and Drug Administration-approved drug of its type. Aprepitant has been proposed to function in combination with other oral anti-emetics for a specified population of Medicare patients receiving highly emetogenic chemotherapy.

Indications and Limitations of Coverage

B. Nationally Covered Indications

Effective for services performed on or after April 4, 2005, the Centers for Medicare & Medicaid Services makes the following determinations regarding the use of aprepitant in the treatment of reducing chemotherapy-induced emesis:

The evidence is adequate to conclude that the use of the oral anti-emetic 3-drug combination of aprepitant (Emend®), a 5-HT3 antagonist, and dexamethasone is reasonable and necessary for a specified patient population. We have defined the patient population for which the use of the oral anti-emetic 3-drug combination of aprepitant (Emend®), a 5-HT3 antagonist, and dexamethasone is reasonable and necessary as only those patients who are receiving one or more of the following anti-cancer chemotherapeutic agents:

  • Carmustine
  • Cisplatin
  • Cyclophosphamide
  • Dacarbazine
  • Mechlorethamine
  • Streptozocin
  • Doxorubicin
  • Epirubicin
  • Lomustine

C. Nationally Noncovered Indications

The evidence is adequate to conclude that aprepitant cannot function alone as a full replacement for intravenously administered anti-emetic agents for patients who are receiving highly emetogenic chemotherapy.

D. Other


(This NCD last reviewed June 2005.)

Transmittal Number


Revision History

06/2005 - Extended coverage for use of oral anti-emetic three drug combination of aprepitant (Emend®), a 5-HT3 antagonist, and dexamethasone for specified patient population. Defined patient population only those receiving one or more anti-cancer chemotherapeutic agents of carmustine, cisplatin, cyclophosphamide, dacarbazine, mechlorethamine, streptozocin, doxorubicin, epirubicin or lomustine. Effective date 04/04/2005. Implementation date 07/05/2005. (TN 40) (CR 3831)

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

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