Late last year, Medicare changed its rules regarding coverage of off-label uses of medications used to treat cancer. The new rules expanded the number of guides (known as compendiums) that the government health plan uses to authorize the use of a drug for a given form of cancer, and made the compendiums the sole source of information on which treatments will be covered.
Since then, controversy has arisen over the rules, which materially change Medicare's coverage policy. Drugmakers and some oncologists support the changes, which give oncologists more flexibility in choosing cancer drugs. However, critics contend that there are potential conflicts of interest involved in using only compendiums, as some publishers have strong financial ties with the pharmaceutical business. Some suggest that the compendiums unduly favor the use of new drugs, which can cost up to $10,000 per month.
Meanwhile, if the new rules remain in place, they are likely to influence what drugs private insurers cover, as commercial health plans usually follow Medicare's lead, analysts note.
To find out more about this decision:
- read this Kaiser Daily Health Report piece
Medicare limits cancer drug payments
Cancer care not affected by Medicare cuts
Patients harmed by Medicare anemia drug policy