MEDICARE TO EXPAND COVERAGE FOR HEARING LOSS AND COVER APREPITANT FOR CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING
The Centers for Medicare & Medicaid Services (CMS) announced today that it will expand coverage of cochlear implant devices to help treat severe hearing loss and will cover an additional oral drug to treat chemo-therapy induced vomiting.
CMS is expanding current coverage for cochlear implants, which are used to treat bilateral pre-or-post linguistic, sensorineural, moderate to profound severe hearing loss. Previously, Medicare covered cochlear implants for beneficiaries with open-set sentence recognition test scores of 30 percent correct or worse.
Under today’s decision, Medicare will cover cochlear implants in beneficiaries who have test scores of 40 percent or less correct, and will cover cochlear implants in beneficiaries who have open-set sentence recognition test scores over 40 percent up to 60 percent if they are participating in a clinical trial of cochlear implantation that meets the requirements outlined in the national coverage decision.
“This decision provides a way to better quality of life for many beneficiaries who did not previously qualify for Medicare coverage of a cochlear implant, and it will help us learn whether even more can benefit significantly,” said CMS Administrator Mark McClellan, MD, PhD.
CMS also is covering the addition of aprepitant (Emend™) to the existing combination of two other drugs used for the prevention of nausea and vomiting when patients receive any of the specific chemotherapy treatments.
These treatments, known as highly emetogenic chemotherapy, have been identified by cancer experts as causing severe symptoms in most patients who receive them. The new three-drug combination consists of aprepitant, dexamethasone (a corticosteroid) and a 5HT3 antagonist, and is administered immediately before chemotherapy, with additional doses given afterwards. The addition of aprepitant will improve symptoms for those patients who do not have complete response with other drugs.
“This is a significant step in our ongoing efforts to provide the best cancer care for our beneficiaries,” McClellan said.
These final coverage decisions are available for review at the CMS coverage website www.cms.hhs.gov/coverage. The decisions are effective today.