CMS Moves to Curb EPO Use

The Center for Medicare and Medicaid Services yesterday proposed sharp cutbacks in EPO use by oncologists treating cancer chemotherapy patients. The agency clearly had been waiting for the results of last week's Oncologic Drugs Advisory Committee meeting at the Food and Drug Administration.

The proposals can be found here. In brief, the agency proposes to turn down payment for EPO if the cancer patients have underlying heart conditions; if their anemia is related to radiation; if their anemia isn't cancer-related; or if they are taking anti-angiogenesis drugs like Avastin.

The agency also says it won't begin paying for Aranesp or Procrit (Amgen's and J&J's anti-anemia drugs, respectively) until red blood cell counts drop to 27 percent, which is a hemoglobin level of 9 grams per deciliter. CMS also will limit total usage within any four week period, cap payments to 12 weeks per year, and cut off payments if patients respond poorly to the drugs, according to the proposal.

Even though last week's meeting documented the higher mortality associated with excessive use of these drugs, expect Amgen and J&J, not to mention some oncologists who are profiting handsomely from higher usage, to issue howls of protest over these proposals. Deadline for comments is June 30th.