ESA Update: House Members Introduce Bill to Require CMS to Reverse Medicare Coverage Decision for Anemia Medications

October 5, 2007 – Reps. Anna Eshoo (D-Calif.) and Mike Rogers (R-Mich.) have introduced a bill (H.J. Res. 54) that would reverse a CMS decision to limit Medicare coverage of ESA therapy for cancer patients.

The legislation would require CMS to reverse the decision. The House has not scheduled a vote on the bill, which requires approval from Congress and President Bush. Policy analysts believe the legislation will likely fail, but still puts increased pressure on CMS to revisit its policy. Earlier this month the Senate passed a non-binding resolution in support of CMS reopening its coverage decision.

In a letter sent to CMS on August 8, ASH recommended that Medicare reopen the decision to allow maintenance of ESA therapy when the patient's hemoglobin is above 10g/dL but below 12g/dL, consistent with the Society's practice guidelines. Recently CMS sent a letter to ASH and other interested groups indicating that it would not revise the decision without additional evidence. ASH continues to work with CMS and Congress on this important issue and will keep members apprised of new developments. ASH will post its response to CMS on the ASH Web site in the next couple of weeks.

Additional details concerning ESA coverage are available in Policy and Practice News.