ASH Successful in Influencing Local ESA Policy in J4 Region

October 31, 2008 - Trailblazer Health Enterprises, LLC, the Medicare Administrative Contractor (MAC) in the Jurisdiction 4 region (J4) released a notice of the finalized Local Coverage Determination (LCD) for Erythropoiesis Stimulating Agents (ESAs).  The LCD is currently in notice period and will be effective starting December 15, 2008. The J4 region includes Colorado, New Mexico, Oklahoma, and Texas.  

All of the ASH recommendations submitted to Trailblazer during the LCD open comment period were included in the final policy.  ASH was influential in changing the following items.   

• Provide coverage for darbepoetin alfa (DPO) as well as erythropoietin alfa (EPO).
• Provide coverage for ESA treatment for patients with a pretreatment EPO level of less than 500 MU/ml.
• Allow for ESA treatment of patients with a bone marrow blast of less than 10%.
• Provide coverage for ICD-9 codes 238.72 – 238.75.